HomeMy WebLinkAboutBuilding Permit Application"" . A
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10 d 1 - � Permit Number:
41
RECEIVED 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 LOCATION:
Address: ((J-J -in, R OU4 Lh Q IQ-Y�E�E 2_q!3 7
i
Legal Dpscription: 1 �� - I �. VV - U 1i o sic r%S g
D 1, i -- 72-07 I Y.
Property Tax ID #: l 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:.
DETAILED DESCRIPTION OF WORK:
(I"t_ - f Ob P W c+-V) V-Y\t f' l f9 v
CONSTRUCTION INFORMATION:
HUUMUF]dI wUrR LU UC tIUFHMU U11UM 1111b pt![ 111 IL — U IMA dil Ll Id L dPply:
IIHVAC Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
11 Electric 0 Plumbing [:]SprinklersEd Generator oof ® Roof pitch
Total Sq. Ft of Construction: I SbO S . Ft. of First Floor: 1206
Cost of Construction: $ (000 ® Utilities:Sewer ; is Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name wmn I i (
Name: MW I,U1,U Ita to
Addrem (Jf vk 10 �
Company:
ciplCity:
1)%V1 ' State:
`Y'
Address: u, J I&IAIW 91 N
s
Zip Code: C Fax:
City: 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: f,(,( I27%902
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 td build the subject structure
which is in conflict with any applicable HomjWwners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home,Ow; ers Association and,review your deed for any restrictjons which may apply.
In consideration of the granting of this/eques'ted permit, I do hereby agree that I will, in all respects, perform the
in accordance with the approved plans, the /Florida Building Codes and St. Lucie County Amendments.
The following building permit applications a4�e exempt from undergoing a full concurrency review: room additi��hs
accessory structures, swimming pools, fences, walls, signs ��creen rooms and accessory uses to another non-rksid
WARNING TO OWNER: Your failure to Record a�Notice of Commencement may result in your/oayini
improvements to your property. A Notice of Iommencement must be recorded and posted on
before the first Inspection. If you intend to obtain financing, consult with lendr or an attorney
commencingwork or recordingour.Notice of Commencement.
I /I
I use
ce for
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37/
Signature of Own er-/ essee/Contract r as g nt for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA 0 ��U4-u_
STATE OF FLORIDA
COUNTY OF ((f�COUNTY
OF
The forgoing instrume t was acknowledged before me
20� by
The forgaoing instrur,�gnY wa acknowledged before me
this U day of O(�'f'(i ' 20_j:
this ay of
11
I tkx i at\b
LUJU
Name of person,making statement
Name of personmaking statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signat
Commi
ary -tee �)
siE3 '- MY COMMISSION # GG18jyp
(Signature o I- ell t&6bh NEZ
Commission :'= MY COMMISSION #6@JJ4236
EXPIRES June 13, 2021
�; EXPIRES June 13, 2021
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Rev. 8/2/17