HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COWF r-iJED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Permit Number: I1 Q�. M90
RECEIVE®
Building Permit Application JUN 19 ,2017
PERMITTMG
5t. Lucie bounty, FL
Commercial Residential
Address: iD loOO� CJQ� UJV If ',bUt-f JSUS&/.6X%t � jL , ;52fK,T-
Legal Description:_ K.z.�±l_O�£i' _ �r %—e (50.
Property Tax ID #: � ' ��S I ' ���� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Additional work to be pertormed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
�C Electric Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total.Sq. Ft of Construction: /v200 Sq. Ft, of First Floor:
eo
Cost of Construction: 4324,000. Utilities: —Sewer _Septic Building Height:
C®NTRACTO
Name .4 £S C�PQ.l%Wd
"::Name;:. '
Address:,�-S3 W f- aW $/fib
rCo'mpany:{:fi
City: x5"1 `r P %e!? .3° State:
,Address:'?1D,2,S , ,,5;
Zip Code: 7:57 -- ._; - Fax:
City: <<,f- -
State:,
Phone No.
Zip Code: �3 L4q Z Fax:
E-Mail: 0 411 00
Phone No `77 Z 3 9 g q 0(0
Fill in fee simple Title Holder on next page ( if different
E-Mail F9 0 0 rt p
from the Owner listed above)
State or County License 0—G C—
SZZ
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requires.
ENGINEER:
Name:
Address:
Citv:
Zip: Phone_
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
I Address:
State: I City: State:
1 Zip: Phone:
_ Not Applicable BONDING COMPANY: _Not Applicable
Name:_
Address:
City:_
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application islhereby 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 grantinlg a permit will authorize the permit.holder..to:build the subject structure
which is in conf lict.with any applicable Home'Owne6 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) ['do Hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Build Ing 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, sign�is, screen rooms and accessory uses to anotherinon-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
rommpnring work or recordine vour Notice of Commencement.
Signa ureo�Owner s e/C ntractor as Agent for Owher
Signature of Contractor/Lic older
GGJ cf`
.
STATE OF i
t
STATE OF FLORIDA
OFiw�a
COUNTY OF
COUNTY
The forgoing instr ment was acknowledged before me
The forgoing instrument was acknowledged before me
this �Q day of 200 by
this _�k day o 20 n by
�J
(Name of person acknowledging) -
(Name of person acknowledging )
(Si r of -State ef-Fivrida
Ale v Y r K,
at re of Notary. Publi )
Personally Known OR Produced Identification _
Personally Known OR Produced Identification
Type of Identificatio I
rs t c e
Type of Ident' icati n
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Produced
ERAMAGIONCAI rA
Commission No. State of New
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Produced �-=-•
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Commission No. e' + �* S�Comm.
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',�pOpe��;;°•'' ,Commission # FF 1 i
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REVIEWS
F O
PLANS
VEGETATION_
SEA TURTLE „
MANGROVE
ZONI G
SUPERVISOR
COUNTER
REVIEW
REVIEW
REVIEW
_
REVIEW.' `
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014
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