HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE C011WILE iED FOR APPLICATION TO BE ACCEPTED
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Permit Number: 11 0� - Goss
RECE'1V7_D AUG 02 2017
Planning and Development Services Building Permit Application
Building and Code Regulation Division AUG 7 2017
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial--. Residential
PERMIT APPLICATION FOR:
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Address: cob
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Legal Description:
Property Tax 1D#:_1, Lot No
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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St. Lurie County
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HVAC
Gas Tank
Gas Piping
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Electric
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Sprinklers
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total Sq. Ft of Construction:
Sq. Frblf First Floor:
OSt of Construction: Utilities: _Sewer Septic
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Name 1i a IIEN r"V t-+ r I I A.
city. C P..State:T-1-
Zip Cod : Fax:
Phone No.
E-Mail:
Fill In fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR: .. .1. . I � - 0
Building Height: _.
Name: -L -;7---Z \.-) .
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Company: -U-e-_Q -\2 D-)
Address: zb3"\,LAk
City:
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Zip Code: 2aiFax:�) 61.2- --3!q b
Phone No. 6
E-Mail: C
-State or County License: CG(L jr:�,-2 z_=, t)
- u= u, f-unstruction is $2500 or more 01cr I
,a "111-0 Notice Of Commencement is required.
utbilt7NER/ENGINEER:
Name:
— Not Applicable M
MORTGAGE COMPANY:
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Address:
Name:
—Not Applicable
City.
Address:
Zip: Phone:
State: City:
State:
Zip:
FEE SIMPLE TITLE HOLDER: ____
Name:
Not Applicable BONDING COMPANY:
Not Applicable
Address:
Name:
City:
Address:
�—
Zip; Phone:
City:
Zip:,_ Phone:
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 ecord&your Notice of CommenrPmpnt
Signat a of Owner/Les e/ ctor a Agent for Owner
STATE OF FLORIDA
COUNTY OF_
The forgoing instrument was acknowledged before me
this �g day of 20 V�- by
in co `_ U.
(Name of person ack owledging )
kL /P /_"_' � �
(Signature of Notary Public -.State of Florida }
Personally Known �_ OR Produced Identification
Type of I denfif jcwmh r u _ . _ __ _ ._
Commissioni.1Lr MY COMMISSION #
Revised 07/15/2014
1 � � w
Signatu of tractF�Li H er S
STATE OF FLORIDA
COUNTY OF�e2k_ 1v u e
The forgoing instrument was acknowledged before me
this day of 20i by
(Name of person acknowledging )
(Signature of Notary Public- tate of Florida )
Personally K P ducedt'ion
Type of Iden if' ., raga LA LUZ VE .
1 '•: �'= MY COMMISSION OW03OW
Commission ` , , „ EXPIRES NovemberRe2a4go
REVIEWS FRONT ZONING SUPERVISOR PLANS
COUNTER REVIEW REVIEW REVIEW
ATE
INITIALS
VEGETATION SEA TURTLE J MANGROVE
REVIEW REVIEW I REVIEW