HomeMy WebLinkAboutBUILDING PERMIT APPLICATION 6-9-17All APPLICABLE INFO
�MUST
�BE COMPLETED FAR APPLICATION TO BE ACCEPTED s
Date: ' 9 ' f� / Permit Number: / 706 — U ,� :�q
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I RECEIVED
_ Building Permit Application JUN /9 2017
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-15.78 Commercial Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:
-ea^q,4-11
Property Tax ID #:
Site Plan Name: / ^
Project Name: OC-eepvx '\'z:6 O r -C
Setbacks ' Front rf-o , Back: �' Right Side: S_-0 'Left Side:
�� iwecnanicai _ k3as i anK _ t3as viping
Electric G�<umbing _Sprinklers
d -e
,)nutters
Generator
Lot No.
Block No.
_ vvinaUws/uuurs
Roof Pitch
Total Sq. Ft of Construction:& 43 Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer' _Septic Building Height:
Name -J-e%hr k;� aVevNF6,Cr'
Address: e 1 S P I . Vve
City: at 6l0 (-Q � State:
Zip Code: 003E 4e, Fax:
Phone No.a - •- _
E-Mail: 14u ri, e 3y @cvlcn I;ne';If
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUP I MEAMNO
C3 LIE W NiFQ +MAi' N.
DESIGNER/ENGINEER:
Name: 0
_ Not Applicable
I _-t
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
I
Address:
City:cfV-e �-o
I State: '
City: State:
Zip: Phone�`�,
�`
-2-1
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY: _Not Applicable
Name:
I
Name:
Address:
I
Address:
City:
I
City:
Zip: Phone:
Zip: Phone: I
I
OWNER/ CONTRACTOR AFFIDVIT:IApplication 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 representatio9ll 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 ref uested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, tie Florida Building Codes and St. Lucie County Amendments.
The following building permit applicatio-1s are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences walls, 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.
STATE OF FLORI
COUNTY OFF
The forgoing instrui
this _!�_ day of =
as Agent for Owner Signature of Contractor/License Holder
nt was acknowledged I
A A C - 1201�
(Name of person acknowledgYng )
of Nqf y Public- State of;Florida )
Personally Known OR
Type of Identifi
Produced I T-)' _1..
Commission No.
9,T
Identification
Ic .
(Seal)
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of , 20_ by
(Name of person acknowledging)
Y
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced
Commission No.
(Seal)
REVIEWS
FRONT
ZOiNING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
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