HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE iINF7, MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: "1 Permit Number: ! _/0 ZS ,y1 �29
REC.a
Building Permit Application AUG / 8 2017
Planning and Development Services
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: Dh&41
Address: Soinfo. w-
Legal Description: /.0 `L� fv rg �1-e
Property Tax ID #: 13 p ( 6 D q 616 ,y O oo Lot No.
Site Plan Name: Block No.
Project Name: 114)—1 :.. 1x4"t I,iN�
Setbacks Front r �, ` Back: Right Side:` 5 Left Side: -
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
I.
X Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
otal Sq. Ft of Construction: Zbly' Sq. Ft. of First Floor: tk_yy
Cost of Construction: $ o n Utilities: :_Sewer _Septic Building Height:
OWN R/L�-�SSEE
C NTRACTt+�R:
Name 9r,gri �o f'l i/l �-}o✓l
Address: 7 S6 S �, y�l-a 0 5 c�
City: jnf P�
Zip Code: 3-Z qV_ Fax:
Phone No. ?�2 ��� 6
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State: (
Name:
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
E-Mail: r i 5e e IfQ p, 4 1.. n-i
Fill in fee simple Title Holder on next page
from the Owner listed above)
L
if different
State or County License
of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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StJpPLEl1lIENiAI. CQNSTR�UCTI® I.1�:EN LA�lll 11�1FORnlIAT't0
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DESIGNER/ENGINEER:
Name? _tWJL-N'&r0•5
_ Not Applicable
follo P,I 4,P1 5 1
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address. PO &K Lv6-7
City:®LA c% IeS
Zip: �� �` Phone
i
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(�3 ���i
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
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
whid-, 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 your Notice of Commencement.
S �E p �(Owne / Lessee/Contractor as Agent for
r ` +Signature of Contractor/License Holder
STATE OF FLORIDA -
STATE OF FLORIDA
COUNTY OF
�• COUNTY OF
s Xn
The fqtgoing instru t was acknowledged efore m
this day of 20 �by
2 ms fThe forgoing instrument was acknowledged before me
co this day of by
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wp r 1 •-E )�L
C �T 2
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(Name of person acknowledging)
(Name of person acknowledging)
(Signature of o ry Public- State of Florida
(Signature of Notary Public- State of Florida )
/
Personally Know OR Produced Identification
v Personally Known OR Produced Identification
Type of Identificati n
Type of Identification
P�oduced
Produced
i
Commission No. (Seal)
Commission No. (Seal)
,REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
C>^�
RECEIVED
C� �CJ1t
DATE
COMPLETED
Rev.