HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONINK--
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ALL APPLICABLE INFO MUST-H C,...,r4ETED FOR APPLICATION TO BE ACCEPT �uJ
Date: D - orJr— Permit Number:
RECEIVED
Building Permit Application AVO Z 5'2017
Planning and Development Services-"'TTING
Building and Code Regulation Division v�• �- c i4 County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of fine II
Address:
Legal Description::
Property Tax ID #: So I Lot No.
Site Plan Name: 1 /Ak 1 C A,aLj S Block No.
Project Name: ["W Q, QA(Z&Al2A 9Pg 6n &k
Setbacks Front O Back: j e ' Right Side: 1 O , Left Side: / 1
' f3�� aSo (�all�n/ Ro�Mle TNL� .. �",,Isr�ll
�N��Ro4N� GAS
L.4es -
FEES ooL. YekT k CooKT-ajA ;t-'GA i i C
TilSrA t �
CONSTRUCTION 1NFORMaTIOrI f
work o
Additionalunder
. t �..,
e pert, a un er t is per - check a tat apply:'
t , t
_ HVAC
ank Gas Piping Shutters
—
Windows D
_ / oors
_ Electric
_Plumbing _Sprinklers _Generator
_ Roof
Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Name CQd_ & +-- AANA" 1 'j*Nne•K Name: TkKqVa.a.�
Address: ;-9o0 Sa6'77�1 aCEA,1 'bA%ye . Company O
City: T�J Ste, f �.� C Stater Address:. LJ w �1
Zip Code: 3 4 9 5'+ Fax: City: 'PA LL—A e,-ty State. -_.FL-
Phone No. Zip Code: 3y 49 10 Fax:
E-Mail: Phone No. ��� -��'�. - 130� Tyrjo / S
Fill in fee simple Title Holder on next page ( if different E-Mail--Ad LfvD &,HQa, a -I Cam
from the Owner listed above) State or County License:
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
r
DESIGNER/ENGINEER: — Not Applicable
MORTGAGE COMPAN .Y: 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.
(.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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or anscovenants 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 your Notice of Commencement.
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L21 MML �r
COUNTYSTASTATE OF I COUNTY OF ORIDA��
The forgoing instru ent was acknowledged before me
this&tay of 20Z?by
(Name of per n acknowledging)
The forgoing instr ent was acknowledged before me
this,.",ay of 29J7 6y
(Name of pe n acknowledging)
(' ure o Notary Publio- State of Florida) (sign we of Ndfary hu6to- State of Florida )
P rsonally Known /OR Produced Identification ersonally Known OR Produced identification
ype of Identification Produced Type of Identification Produced
JANE L. CO 9 G GO %-6
Commission No. "�'®" �otary P(�t)g�ate p36070a Commission No.
r�� :c• E Commis cYohe Dec JPNE L. Crae oti Ft�'�a
REVIEWS I PLANS
CO N E j1;,•, REVIEW s PERVISREVIEWOR I REVIEW.
DATE
COMPLETED