HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICAB7NF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Op / Permit Number: 11��' GRI-S
.—M4 Y; 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
ern
P.Rr3PCIS
ED. I (VIFROVEM ENT..LOCA1'I ON
Address: f%s '��
Legal Description: 1-665420p0 ON�� (/!?�/ i Zor-s 3 '4-X
Property Tax ID #: Z, D/-- � gzD 2-- DUO - 3 Lot No.
Site Plan Name: �,d Tf/l Block No.
Project Name: 1f2 7—F�
Setbacks Front Back: 3 3. (� Right Side:_ Left Side: 62,Z 3--
HVAC
Electric Plumbing Sprinklers
Total Sq. Ft of Construction:G�
Cost of Construction: $ �Ilu, D Od Ut
ng 0 Shutters Q Windows/Doors
Generator 0 Roof Roof pitch
S�Ftj of First Floor: ' -a U
ilities: —Sewer Septic Building Height:
OWNERjLESS.EE -
CONTRACTOR
Name 141//5 '7 4
Name: VA J,4,Z,0 &dG
Address: / w v�
Company: l4 t/k DtiOIL!l
Address: bo /J!a
City: Chi001, State;�l
Zip Code: Fax:
Phone No. 7 7 Z Z/ / % f �7
City: v e/IGi
Zip Code: S �ej--/ Fax:
Phone No. 22, Z 5-Y
State: /-,-'/
7S
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: 7Wt/ a ZA d6 6O L-4)1 kz AP5
State or County License: r /j L 17, 5-3/1fo
If'value of construction is 5z5ou or more, a KeLUKotU Notice or Commencement is requuea.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: ket, '::y' S.6141, Name:
Address: gel, Address:
City: / A'ewcf State: City: State:
Zip: Phone 77z %fib 775-1 Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:_
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
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 failure to Record a Notice of Commencement may result in your paying twice for
improvements toy ur property. A Notice of Commencement must be ecorded and posted on the jobsite
before the first irection. If you intend to obtain financing, consult yh lender or an attorney before
commencing wortk or recordingWour Notice of Commencement. / i1
Sign atu Owner/ Lessee/b6ntractor as Agent for Owner
Signa •e of Contractor icense Holder
STATE OF FLORIDA
STATE OF FLORIDA
7-1-1y-Z
COUNTY OF �S%d%!/G!�
COUNTY OF
The forgoing instrument wa acknowledged before me
The forgoing instrumenLwa cicnowledged before me
G
this J-"ay of l¢t'i> 2017 by
this % day of 20/,7 by
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary P lic- State of Florida)
(Signature of Nota Public -_State of Flr,
Commission No. C p if�Nt�MARIEGi\JENS ,
022023 N
,e DEAIVNA�CA_RIE'GIVENS
Commission No. �E1 yCr)k4?AI=6 G6?1023 �fi
ca° i "....o �. M'f comwssION # GG
-* �= EXPIRES:Decem bet 16, 2020
x : EXPIRES: December 16, 2020
'°'
':;e�" Bonded Thni Notary Public UndeiwriteM-!�
, �., a`e Public Underwr tors
r Notary
REVIEWS
FRO
N NI G
SUPERVISOR PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17