HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Idut.. l o Permit Number:
�I + RECEIVED SEP J 2017
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
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Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PRQP�SEC3 I I:R�1l�,E,�/IENT F GATIQ
Address:
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Legal Description:
Property Tax ID #: 1 Lot No. l�
Site Plan Name: 4 Block No.
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Project Name: W c
��2'�_
Setbacks Front Back: Right Side: Left Side:
DETAILED D@RIPTIO 01= U1/OR
coN�T� CT a )N� o �ATtO .
Additional wor to be i3efformed under this permit - cneCK all apply:
0HVAC Gas Tank Gas Piping Shutters Q Windows/Doors
_
11 Electric 0 Plumbing Sprinklers E Generator 1:1 Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ aZ �o� (o - 46 Utilities:[]Sewer ElSeptic Building Height:
0 .AIL S'SI! ti
CC+� TRACT � �:
Name C �L
Name-
Address: -
Company: SG(e Inc -
City: YV
State.
Address: 2SL151N1 \
Zip Code: 4 Fax:
City: �.�2-aC�► State: �-
Phone No. /
Zip Code:Fax: S
E-Mail:
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Phone No. 9''> - 60261
Fill in fee simple Title Holder on next page ( if different
E-Mail: i\I►r � a� c ✓\P jak to\A eve ,i .,�, ec;
from the Owner listed above)
State or County License: 422 0-u
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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'SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: a -F c, r Name:
Address: Address:
City: State: f City: State:
Zip: _ 31 ~v Phone: " 7 7 -)_ 5�� —12-imO Zip; Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING:COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in. conflict with any applicable Home.Owners Association rules; bylaws:or:and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The -following building permit applications:are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your fa' re t Record:a Notice of Commencement may result in your.paying twice for
improvements to -your prop y. A otce of Commencement must be recorded and posted on the jobsite
before the first inspection . �o u i end to obtain financing, consult:with lender or an attorney before
commencini; work or r >�1fi9 v ur Notice of Commencement.
Owner/lessee/Contractor as
STATE OF FI
COUNTY OF
The forgoing instr ent was acknowledged. before Ve
this/6 day of _ 20 N% by
(Name of person acknowledging)
Aoi�v Lav-7
(Signature of Not Public- to of Florida
Personally Known rods IBIIlit0>iii3
Type of Identification Pg
Q MY cornrvtir6 on
Commission No. O,,.o� ExpiroI- 9621
Revised 07/15/2014
s
Signa ure of Contractor/License Holde
STATE OF FLORIDA�
COUNTY OF
The forgoing�instru grit wa acknowledged before me
this t day of �0 by
(Name
710—M
of
Personally Kno n L)A_ OR Producel ®rptif
Type. of ldentifi, ation Produced y %
Commission No.- �d�l
fa cg O
fA i
REVIEWS
FRONT ZONING
SUPERVISOR
PLANS.
VEGETATION
SEA TURTLE
MANGROVE
COUNTER REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
1
INITIALS