HomeMy WebLinkAboutBuilding Permit Application 11-3-17ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q y
Date: B ; /�7 Permit Number:
Building Permit Applica i � GENIE®
Planning and Development Services
�E
Building and Code Regulation Division NpV 0 3 2017
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residgtial �ent
rml In
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at tFgeWgqnpqpnty..
FL
Address:
Legal Description:
PropertyTax ID #: J
Site Plan Name::
Project Name: �J
Setbacks Front Back: Right Side:
10
Left Side:
Lot No. 4_7
Block No.
i on a Fia�� J J
—RUW1101 VVU11% w uc c11u1111cU UIIUCI LIIIJ PCIIIIIL—LI
11HVAC _ Gas Tank []Gas Piping
11 Electric 0 Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ C.366.00
aPPiY:
_ Shutters Q Windows/Doors
IGenerator 0 Roof
Sq. Ft. of First Floor: _
Utilities: Sewer Septic
Name t�
Address:
City: State:
Zip Code: Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Building Height:
Name: v / 1 • ' /LcSIlI i
CompanylC—(a C% l A,0
Address:
City: 1,,Ui Atate:4-c—
Zip Coder �?`/// Fax:,l-�CJ�-
Phone No. at,
E-Mail:sr.1�?h'ttt/,r�i�ans�
State or County License: q 2-
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
,MORTGAGE
DESIGNER/ENGINEE�
Not Appiica a
!MY-*,
_ Not applicable
name »CCU
Address• '��3h h
1 : ire �n
j¢ me:
_dress•
City: act r c ,
Stater
City;,
State:
Zip: L( Phone:
797=S7S_�L- cnra
Zip: Phone:
FEE SIMPLE TITLE HOLDER:;
_ Not Applicable
BONDING COMPANY
Not Applicable
Name::
Name:
Address:
_
—M
Address:
City:
City:
Zip:: Phone:
Z,p;: Phone:
I certifythatno:work or installation has commenced priorto:the issuance of a:.
St. Lucie Count makes no..representation that is granting: --a perrriit will authorize the permit holder to build the subject structure
which is in con ict with any appiicable.Home Owners Association rules; bylaws or and covenants that -may restrict orprohibit 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, l.do-hereby agree that 1 will, in.all respects, perform the. Work
in accordance with the approved plans,, the Florida Building Codes and: St.. Lucie CountyAmendments.
The.foiiowing.building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swirnming'poois, fences, walls, signs, screen rooms.and.accessory uses to another.non-residentlal.use
WARNING TO OWNER: Your failure to Record a Notice of Commencementmay result in your payingtwice for
improvements`to your property. A.Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If.yo intend to obtain financing,, consult With lender or an attorney before
commencimmork or record our Notice of Commencement.
4*1
Signature of Owner/ Lessee/Agent 'signZE
a of Contra /L,ce0§noTder
STATE OF FLORIDAAajx� STAOF FLOWP /r
COUNTY OF ,/Jn COUNTY OF j'? ��� ���;ti� 1� O..uv/t�'y_
The f rg ing instr nt as ac owledge before me The forgoing instrument was acknowledged-before'me
this day of 20 by this day of.'' Ci 0 4-Ob e r 20 7 by
{Name of person acknowied P g:) (Name Of p-erson acknowledging)'
l•
/�
(Signature of Nota Public- State of Florida:) (SignatLW4of No ary Public/State of Florida )
Personally Known t OR Produced.ldentification Personally Known OR Produced identification
Type of Identification Pr Type..of Identification Produced .. .
Pv� Notary Public State of Florida
Commission No: . Fragy0gf wza Commission No.
My omm Ion GS o®2440 '0��ft Pia CHA JOHNSON
of Bxpiroa 0712712021 ;:°, .`c'; Notary Public -State of Florida
A
'�r a°`� M Comm. Expires
Oct 26, 2019
Revised 07/I5/2014 �'�O°P,` Bonded through National Notary Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE.
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS