HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED; i l
Date (9 • %7 • ��. Permit Number:
OECEIVED
LA ;,a':. _ I
s. - r -
Building Permit Application JUN i 9 2017
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-15.53 Fax: (772) 462-1578 Commercial Residential C
PERMIT APPLICATION FOR:
'Address: 'Foo i Y--c A. 1) r•/•A—e rc_:41 ,
Legal Description: h (% /'!% ��'i !% Gl•%�
'Property Tax ID #:
DoZ -�arl� d - U' C90` Lot'No.
Site Plan Name: Block No.
Project Name: "
Setbacks Front-,_ Back: Right Side: Left Side:
—Mechanical — Gas Tank _ Gas Piping - Shutters ;, _Windows/Doors
Electric Plumbing —Sprinklers ' : Generator Roof Pitch
A
Total Sq. Ft of Construction: Sq. Ft. of First Floor: T�
Cost of Construction: $ s 7 - d_ Utilities: — Sewer ' —Septic Building Height:
Name _J�Gi A e- f' k T_enfS
Address: 45LY ov ,0& %r c, A h r v I! P
City: F77' P i P f re State:'
Zip Code: U g`a Fax:
Phone No. 7171 V 6/-
E-Mail:
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.
SUPPLEMENi'AL C®NST'RIJCiI®N LIEN L�11N LN��ORNlATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: ^ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
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
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
rnmmpnring wnrk nr rprnrding vour Notice of Commencement.
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Sig at re of Owner/ Less- /Contractor as Agent for.
-
Signature of Contractor/License Holder
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S E OF FLOR
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STATE OF FLORIDA
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CO NTY OF
COUNTY OF
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The instr ent was acknowledged before
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The forgoing instrument was acknowledged before me
Ifooing
thisday of 20,1 by
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this . day of , 20_ by
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C �T � TO
(Name of person acknowledging)
(Name of person acknowledging)
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(Signature of N ry Public- State of Flo a)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
/
1'
Personally Known OR Produced Identification
Type of Id4'fi�.ation
Type of Identification
Produced
Produced
Commissi(Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014