HomeMy WebLinkAboutBuilding Permit Application.tl t
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ALL APPLICABLE IN MUST BE COS TED FOR APPLICATION TO BE ACCEPTED
Date: Y7- it -�
Permit Number:
Building Permit Application R E C E 0 V
Planning and Development Services AUG / 7 2017
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential __Y""_
PERMIT APPLICATION FOR:
PROPO ED S MPROVEMENT LOCATION
Address: c �Y'- CV A Or� —. L) •� I
VF
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Legal Description: L��� UJe�O�1 j�Z� t �� C) _.
Property Tax ID #: ���� —�c�� —C7� �b Qm—Lot No. 2
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIO N, OF WORK
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CONS TRUCTION7,INFORMATAddION a,
itiona wor to a pe ormea un er this permit— checkcheEk a tat app y
_/HVAC _Gas Tank _Gas Piping _•Shutte�'s7Vuitnc
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Electric — Plumbing — Sprinklers Gen DATE: '1
/� oved � j7" oof pitch
Total Sq. Ft of Construction: Sq. Ft. o _ s b�ir"a A � rer ; a P
Cost of Construction: $ ®a Utilities: _ Sew c
11 � g i t
OWNER/LESSEE
CONTRACTOR
Name iSgz�, e 7— Name: S CAXZ
Address: ° Company: v \
City: e Stater Address: L
Zip Code: Fax city: IC'�-i`�
y. ��) V"' 'p,e� a State
Phone No.%, hAZ--qW \ Zip Code: ?a Li t f Fax: �0 6 2--`}[g b
E-Mail: Phone No, LYNzi ?jL[2-- 6R 2$
Fill in fee simple Title Holder on next page (if different E-Mail: )IC112 in 1-0 X
from the Owner listed above) State or County License: C C C is?— i rj 0
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required
SUPPLEMENTAL CONSTR;UC X N LIEN LA.
DESIGNER/ENGINEER: — Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
W INFORM'ATION
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
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 recording our Notice of Commencement.
JSignatur Owner essee/ ntra Agent for Owner Signat of C tracto icehse Holder-'S
STATE OF FLORIDA
COUNTY OF �V P
The foXoing instr ment was ac! owledged before me
this W day of 20 t_)--by
(NaWe of person ackno ledging )
(Signature of Notary Public- State of Florida )
Personally Known OR Produced
Type of Identific ia- uce ..a. , . , .
Commission, No. '~ MY COMMISSIONGO50399
ES Nova 8, 2020
--------------------------
Revised 07/15/2014
REVIEWS ' FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
)ATE
�OMPLETE
INITIALS
STATE OF FLORIDA
COUNTY OF_
The forirng instrument was acknowledged before me
this _L'�L day of - 20 OL by
(11mbe of person ackn wledging )
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identificatio
Type of ldenti ro
Commission N : � :MY COMMISSION #/�1130399
Novembbl' � 20
PLANS EREVIEW
ION SiREVkIEWTREVIEW
ANGROVE
REVIEW