HomeMy WebLinkAboutBuilding Permit ApplicationAML
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 Permit Number: )1 CA' d a.1
RECEI`.'rD AUG 14 2017
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 349B2
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line 0�h
PROPOSED IMPROVEMENT LOCATION':
Address:
Legal Description:
Property Tax ID #: HIS' - 213 - OQ / U - 000 - 3 Lot No.
Site Plan Name: �+ 7 j / Block No.
Project Name: J D lA5 Z �cm�, riz6 eoo4c-- e
Setbacks Front I3d . / o Back: f 4D y Right Side: / %e61 LeftSide: 130- 7
DETAILED DESCRIPTION OF WORK:
pa I -e 4 060 /' ,`n &-1 /-
3 �,; Id
11 CONSTRUCTION INFORMATION:.,
Additional wor to e performed
E]
under tispermit-checka
apply:
1]HVAC
Gas Tank
❑Gas Piping
Shutters
2dElectric
0
Plumbing
Sprinklers
Generator
Total Sq. Ft of Construction: 216
Cost of Construction: $ ��, d fib• ;��
S Ft. of First Floor: _
Utilities n Sewer � Septic
QWindows/Doors
Roof Roof pitch
Building Height:
OW N ERAESSEE:
CONTRACTOR:
Name r i.1
Name: ,) c. - e cillnodiae
Address: SAC) 77 /tc 7a 7oa.. /
Company: o/e &MS r�L&4;0-
City: State: 4
Address:
Zip Code: 3 Me / Fax:
City: e Stater
Phone No. 33 2 0-7 D
Zip Code: yy Sf S Fax:
E-Mail: /I1 o �i•14 �. a0t` .Gc��,-,
Phone No. 772 3-)6 S(.27
Fill in fee simple Title Holder on next page ( if different
E-Mail: 4/,r
from the Owner listed above)
State or County License: CSC -1 Sz 053 %
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
rI
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/E INEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:G-v f Wee�`•
_
Name:
Address:
Address: f 9 9 f 5 k% & S',, filly
City: S 1 State: _ F4-
City: State:
Zip: 3119?V Phone 772 75 T 9,9S9'
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 Counter 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 to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorn before
commencing work or recording our Notice of Commencement.
Signat re f caner/ Lessee/Contractor as Agent for Owner
Signatu a of Contractor/License r er
STATE F FLORID
STATE F LORIDA
COUNTY OF �. L i p� i
COUN F ST. W C.l t
The forgoing instrument was acknowledged before me
The forgoing instru nt was acknowledged before me
this day of 20 / 7 by
this day of 20� by
, ; /(
Name of person making statement
Name of persoaking statement
rpOR
Personally Known OR Produced Identification
Personally Known ✓n Produced Identification
Type of Identification
Type of Identification
Produced
Produce
ha-
(Signature of Notary Public- State of Florida)
(Sign r otary o i a
Pry4n Notary Public late of Florida
Commission No. �►*Ncg�j�blic State of Florida
:o�paY
ommission No. Gregory S au
ommis
'bAFCrlSll D PaSchal
c: a My Commission FF 193030
�of ,
o° Expires 05119/20132514
of P
Expires 01'N12019
REVIEWS.
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17