HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: % b - 2 °7- 1 % Permit Number: Io_Q` J?
RECCIVE
Building Permit Application
Planning and Development Services OCT 3 0 2017
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
PR®® IM!PR®UEM'ENT L®CATY®N:WMM
Address: 1 I 1 Q _R_R n E� "� C4 Legal Description: L6+- F. -6) uc,K G hs t.://��
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Property Tax ID #: I q I Y - "1 0 I - 00 S 0 - 000 - 1 Lot No. F
Site Plan Name: S k a_Yhr\h ►' he-ed Block No.
Project Name: Skii_hh j h "RLJ
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Setbacks Front Back: Right Side: Left Side:
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�HVAC Li Gas Tank ❑Gas Piping U Shutters i Windows/Doors
Electric 0 Plumbing ❑Sprinklers Generator [a -Roof
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Total Sq. Ft of Construction: Z- - 4 �� S . Ft. of First Floor: L/ 3 60
Cost of Construction: $ -tS 5'6-0 . — Utilities: Sewer Septic Building Height:
Roof pitch
®WN R IRSEE:
C®NTRACTOR:
Name SINA .i,I:=,
Name• -µ,ink '7'AbM1aSoh
Address: � I'I Qu"jk-eh )= ix. ek t_ G
Company: 7, o sT
City: F4- State: F7l-
Zip Code: 3 4 q �i 9 Fax:
Address: _ 0_ Bb)c 30
City: V.PVO Degc.L State: ��-
Phone No. -77 Z L V 3 - Y3/ L
Zip Code: 32-1 W Fax:1'7Z s(o 4 060
E-Mail:
Phone No. -1-1?- 5764 R)O f'
Fill in fee simple Title Holder on next page ( if different
E-Mail:lllii ielk P %i.0ir.., o►.5119 k-""' to t,'a m
from the Owner listed above)
State or County License: CC C I3al ISO I
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requires.
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S.UPP`LEMENTAL�CONSTRUCTIONLIENLAV"U INFORIVIATIO�N
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
!Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
i 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
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 attorney before
commencing work or recording our Notice of Commencement.
gna urf.T_._ o / Lessee/Contractor as Agent for Owner
Sig ature o C trac r/License Holder
STATE OF FLORIDA
7L'U-6'-
STATE OF FLORIDA �U�r
OF
COUNTY OF
COUNTY :Zg/,"
The forgoing instru ent was acknowledged before me
The forgoing instru nt was acknowledged before me
24Y /1.r by
this &ay of t 20 /7 by
this day of of / 20
Name of person making statement
3i r
Name of person making statement
OR Produced Identificatio
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Personally Known fs OR Produced Identifi
til4iy (;;
Personally Known e/
Type of Identification
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Type of Identification
Produced
Produced
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REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev. 8/2/17