HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONM
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
�� i1 Permit Number:
Date: a �
RECEIVED JUN 13 2017
Building Permit Application
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 FOR: smg�
Address:32-(P 'I
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name: _
Setbacks Front Back:
Right Side: Left Side:
{JL&��" u e> d6)±� t o l?' x it -[Fr
aitional worK 1
_Mechanical
Electric
perrormea unaer
Gas Tank
Total Sq. Ft of Construction:
Cost of Construction: $
Plumbing
permit - cnecK a
_ Gas Piping
_ Sprinklers
apply:
Shutters
Lot No.
Block No.
Windows/Doors
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Name 67)60J� r�= s�
Address: 3Z40 I44MN6V, Sr
City: rc2r2r Ac_V_�- State: (,
Zip Code: 3413 / Fax: ~�
Phone No. 77e7- -2,1& -SO-3
E-Mail: 6414IL
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.
StJPP 11M,11 L CONSTR
GTICiN LIEN I.AW
i.N'
-OfiMA:TEO
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
_ Not Applicable
State:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable
I
a
I
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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
commencing; work or recording vour Notice of Commencement.
Signati fe of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA '
COUNTY OF
The for oing instrument was acknowledged before me
this day of 5-J isk 207 by
i
(Name of person acknowledging )
(Signature of Notary Public tate of Florida )
Personally Known OR Produced Identification
Type of Identification RNOWSWSWOMMIM
Produced ` Ir "+PI •. DEANNA MARIE GIVENS
'? • " MY COMMISSION 0 GG 0221
Commission No. 4 MR: December16,20
,,oF F ;P • Bon ed Thru Notary Public Unden
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of , 20_ by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced
mission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014