HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONL
ALL APPLICABI,E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C9�ZZ Permit Number: l 7 0 G- L7 6-3J
Building Permit Application JUN 2 9 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 FO • `��`
c r ,
PROPOSED IMPROVEMENT LOCATION:
Address: Q / 7 ZAC-A-raV Gv --i�° F
Legal Description: efaAS 4 ,.,a Co U `ZU f 21�4 -
Property Tax ID #: 2 - PO y^ -Oao ^ Z
Site Plan Name:
Project Name:
Setbacks Front Back: 2 Right Side: U SLeft Side:
DETAILED DESCRIPTION OF WO//R��K:
L�rc 2r ,
s��b
20 /o
Lot No.
Block No.
CONSTRUCTION INFORMATION:
itiona wor to e e orme under this permit - c ec a apply:
11HVAC Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
11 Electric ElPlumbing Sprinklers E Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction: 21-s2 5 T S . Ft. of First Floor:
Cost of Construction: $ roG''� Utilities: Sewer Septic Building Height:
.OWNER/LESSEE:
CONTRACTOR:
Name A
Address: g/ 7 r, e-k-5'61A✓ 16414
City: %t::,T P/,e- to G-Ci State: /
Zip Code: Fax:
Phone No. 2' 2, 6 93 ,r!
E-Mail: (,in SGane �IG�tl&w � 4�/o C_QM'
Name: t,✓ �� ���.. �-rvG .
Company: 4 o;v Al f ,v
Address: S S.-Z.vc��ctn� �•y�
City: ce-- Stater
Zip Code: .31190'� Fax:
Phone No. 2�2_
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: 4
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
S,.UPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name: n __'�e
_ Not Applicable
/:--
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address: /
City: State:
Zip: o, ? i n, Phone: _; 2 2 <? z- 9gyy
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable
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.
Signature of Owner/Lessee/Contractor as AgentP�-Rlsr
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDACOUNTYOF
COUNTY OF
The for oing instru t was ack owledged
�
The forgoing instr nt was a knowledged be
this day of 20 %%
this o�dayof� 20/7
Cn
D lV 1b
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of o ry Public- Sta a of Florida (Signature of Nota P blic- State of Florida )
Personally Known —""—OR Produced Identification Personally Known J OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
(O J
I1
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
��
COMPLETE
INITIALS