HomeMy WebLinkAboutBuilding Permit Application INN
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ALL APPLICABLE INFO MUST BE COMPLO FOR APPLICATION TO BE ACCEPTED
Date'- Permit Number:
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RECEIVED OCT 04.2017
Building Permit Application
P,lanning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
hone: (772)462-1553 Fax:(772)462-1578 Commercial Residential _
PiERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED..IM'PROVE M.ENT,LOCATION
Address: 0 7 O W
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Legal Description: Lci Yce 1N 0-ld mitk- I y N 9 1W 11 6 0 C l� to .
Property Tax ID#: ! 3.o l - r'o l t - 0- l' O OJ 5 Lot No. .
Silte Plan Name: Block No.
P oject Name:
Setbacks Front Back: Right Side: Left Side:
fiETAILED DESCRIPTION OF WORK
'7771
[ .CONSTRUCTION INFORM'ATIQN
itiona w ,rk to be Performedunder t is permit—checlk a apply:
❑HVACL_j Gas Tank as Piping Shutters Windows/Doors
DElectric Plumbing Sprinklers []Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of.Construction:$ 0 2 ��� �� Utilities:Sewer 0Septic Building Height:
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OWNER/LESSEE - CONTRAGTQR:
Name �+ b Ct l� Name: t 1
,NYA lei
Address: d3 Q i J E CAD L� A Company: C_QA-51 �,®A (3 J i t,JD &I-I
City: �hr l ��C 2 Stat Address: 3� be)d e
Zip Code: .y 9' ► Fax: city:_\1 v f0 'B eac 4 State: —
Phone No. �W 3,vz- oqby 12 R() Zip Code: 19- Fax:
E-Mail: Phone No. — 0
Fill in fee simple Title Holder on next page(if different E-Mail: C as j e j CJ,n c j : Ne,
from the Owner listed above) State or County License: C GC /.3`0
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
S1UPt�LEMENTAL CONSTRUCTI. tEN LAW INFORMATIRN
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: �- of Name:
Address: v e Address:
City: S-f. Dig irce- State: City: State:
Zip: Pho ne -3 Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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.
Inl 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.
�ifinaturg'of Owner/Lessee/Con ractor as Agent for Owner Signa re of Contractor/License Holder
STATE OF FLORIDA STATE OF FLOI�IIpA
COUNTY OF 4A- LJc'\@ COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instr me t was acknowledged before me
this�day of d iN 20VI by this y day of L 20 V1 by
--'t 0 a 110,r C-1ni :6'►'o-el*L r b46N @.S
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State of Florida (Signature of 0—P -- .yblic-StgebfIpffigm GIs
Commission No. DEgN p�IEGNE22
=�4' .. Y COMMISSION#GG 022023
ttj3�N I ES:Decembe[,U2U0ters
MY COM #GG 022023 Commission N ': Nosy Publi
EXPIRES:December 16,2020 •• off��qe on e
Bonded Thru Notary Public underwriters
,OF Fes•
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17