HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO. MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �b (OPermit Number:l"11a- darn
RECEIV70 OCT 12 2017
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATI N•
Address:
J a C C .c
Legal escription: U iJ i i3 I q R-C
Property Tax ID #: 3 1:3 1 - ! Ob 00-2 '— eD
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
� e —Qom U-1 Yvt� � �v-e �-
�s'4 re
[CONSTRUCTION INFORMATION:
Additional worK to be ertormed 'under this permit — checK all tha apply:
❑HVAC Gas Tank ❑Gas Piping _ Shutters ❑ Windo sL�Doors
Electric ❑ Plumbing. ❑ Sprinklers 11 Generator Roof Roof pitch
Total Sq. Ft of Construction: <G-0 L' So. Ft. of First Floor: ZC} 0
Cost of Construction:.$ �O�o Utilities: Sewer _Septic Building -Height:
OWNER/LESSEE:
CONTRACTOR:
Name Pg'- g rl
Name:
Address: U 6 f 2
Company: Ilu Marto MORNA WjEkc
City: & C-u— C State:
Address: 5 lA)
Zip Code: ZV411— Fax:
city: `� W State:
Phone No.
Zip Code: Fax:
E-Mail:
Phone No.
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the Owner listed above)
State or County License:( I ��
If value of construction Is $2500 or more, a RECORDED Notice of commencement is requires.
SUPPLEMENTAL CONSTR CTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: on
City: —State:
Zip: Ph e•
FEE SIMPLE TITLE HOL ER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: +hone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 grar
in accordant with the app
The follow' g uilding pern
accessory.tru ures, swim
WARNING 0 OWN
improvem is toy r
before the first ins
rnmmonriAl %Ainrir. nr r
ngpffthis requested permit, I do hereby agree that I will, in all respects, perform the work
7d lans, the Florida Building Codes and St. Lucie County Amendments.
aP lications are exempt from undergoing a full concurrency review: room ad ,Olt* ns,
ng ools, fences, walls, si s, screen rooms and accessory ses to anotherp n fesidential use
r'o r failure to R rd a Notice of Commencement ay result i ou paying twice for
r perty. A N ce of Commencement must be r orded a po ed on the jobsite
�. If you i end to obtain financing, consult wit lender ran ttorney before
rriina vnur Nntica of Commencement.
I V X
Signature f ner/ Lessee/Contractor as Agent for Owner
Signature of C actor/Licen Hold
STATE 0 FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
this day of O,j� by
The f rg ling instrument was aci nowledge before me
this: day of 20—D by
Name of person making statement
Name of per ri making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature o �}ablidlH>IeIDFirFIaEEf;iINEZ
=• •e MY COMMISSION # G14236
G1
(Signature ubl - e of Florid
"= MY COIIA e ISsii.=;v A 114236
Commission '?df�c E: ° :_S June �(A21
.• I1
Commission c�;�� EXPIRES June 1PM2+I
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17