HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �1
Date: / 0 • (v• 1"7. Permit Number: 1 ) %/ 0—y l�kp
Building Permit Application OCT ° 6 2017
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 IMV PROVEMENT LO..CATIO��N ;.E
AA&pss:770 2 ? �irep 4 l�Ker c^ Q 5L. .3 47 ej
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Legal Description:
Property Tax ID #: Ai9J %-- ®% 0 d ' ®Q"..3 Lot No.
Site Plan Name: Block No.
Project Name: ITN 1•Ar 0�1 1 V t e
Setbacks% Front Back: '51 Right Side: g Left Side:
DETAIED D LESCRIPTION OF WORK t� c N
r
ec_ -r re -a
CONSTfZsUCTION INFORMATION
Additionalworkto e e orme under this permit— check a apply:
1]HVAC Ei Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 2 r,? s'L ��• S . Ft. of First Floor:
ao
Cost of Construction: $ Z �!`J' Up . Utilities: _ Sewer O Septic Building Height:
OV1/(VE,R%LESSEE
CONTRACTOR
•Name FrunkfA£bLLsL n
Name:
Company:
Address:769 c�= .Fps r�.�
City: *_a'91=e State: �
Address:
City: State:
Zip Code: Fax:
Phone No. � % .2. 7 0 • � q I G •
Zip Code: Fax:
hone No.
E-Mail: •--
Fill in fee simple Title Holder on next page ( i different
E-Mail:
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
P
SUPPLEMENTALCONSTRUCTION'L'IEN'LAW I°NFOR'MATION t
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: ° '' ` —' S
Name:
Address:
Address:
City:dq State: -5 C_
City: State:
Zip: q��E�Z Phone - -
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 to build the subject structure
is in
which 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 failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of - ment must be recorded and posted on the jobsite
before the first inspection. If you intend to ob ing, consult with lender or an attorney before
commencing work recordingour Notice o `�" cement.
�or
0
0.
Signatiures'o 0:wner/j Lessee/Contractor A Agent for
2 o
Signature of Contractor/License Holder
STATE OF FLORI
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STATE OF FLORIDA
COUNTY OF
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COUNTY OF
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The forgoing instrurwrit vyas acknowledged before
The forgoing instrument was acknowledged before me
this W day of ot 20jq. by
`°N
this day of 20_ by
Name of person making statement ✓
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of I i n
Type of Identification
Produced 1
Produced
(Signature of Not ry Public- State of Flori )
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
1
DATE
COMPLETED
Rev. 8/2/17