HomeMy WebLinkAboutBuilding Permit Application, is.
All APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �
�J -7 Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: i(772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Building Permit Application AUG / 2017
Commercial' Residential
2(r Ce
Legal Description: 1-2)
'Pry t -n -rs tJ Kc o ff'C-7
Property Tax ID #: �� r O 60 Lot No.
l
Site Plan Name Block Block No. _
i
Project Name:
Setbacks Front Back: Right Side: Left Side:
Mechanical Gas Tank
_ Electric )) _Plumbing
T to S. Ft if �t/Ust9: L
&-p �(- � � _.—o 00
Cost of Construction:
Nam
_ Gas Piping _ Shutters
_ Sprinkle _ Generator
Sq. Ft. of First Floor:
Utilities: —sewer —Septic
Address: 730 L( 0-1)
City: t:�;t� (tertc State: _
Zip Code: IZgC1SI Fax:
Phone No. -7'1 0/ S
E-Mail:ago op�;M,k -L, CJW
Fill in fee simple Title -Holder on next page ( if different..
from the Owner listed above)
Company:
_ Windows/Doors
_ Roof Pitch
Building Height:
Address:
City: State:
Zip Code:
Phone No
E-Mail
State or County License
Fax:
If value of construction is 2500 or more, a,RECORDED Notice of Commencement is required.
NGINEER:'
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State •
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°tb andther-ndn-i'esidential use
WARNING TO OWNER: Your failure to Record a Notice of �omrrlencgment may,res."lt,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
commeruzing work or recordine vour Notice of Commencement.
u
3SI -- hof�0 ei/ lessee/Contractor as Agent for Owner,
Signature of Contractor/License Holder
STATE OF FLORID
ATE OF FLORIDA
i
COUNTY OF N
UNTY OF
cr �— _
The forgoing instru ent was acknowledged before me a��
'e forgoing instrument was acknowledged before me
this day of y 20 / 7 by d
;as day of , 20_ by
—
> SQ 6r.Z
(Name of person acknowledging)
me of person acknowledging),
(Signature of tary Public-iState of orida U
nature of Notary Public- State of Florida )
Personally OR Produced Identification
Personally Known OR Produced Identification
Type of Identific 'o „/ ,
C l� C
Type of identification
Produced
Produced ( .
Y
Commission No. (Seal)
Commission No. - (Seal) ---
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
�4
RECEIVED
p
DATE
COMPLETED
ev. 1120149