HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONeft`
All APPLICABLE INFO MUST BE COMPLETw rOR APPLICATION TO BE ACCEPTED _s
Date: Permit Number: l O 19
-_ Building Permit Application DEC 12 2017
Planning and Development Services r7 "
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:
I.; PROPOSED" IN`PROVEMENT LOCATION..
Address: 7.3 / 6 9d,.5e ce Gree ./-
Legal Description: ZZ 601— OU25--- 000 q i ,trco(
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
.DETAILED DESCRIPTION" OF WOM: :-
Right Side
Left Side:
Lot No.
Block No.
CQNSTRUCTION INFORMATION
b
W
Additional to e pertormed under this
permit — Check
all that apply:
_Mechanical _ Gas Tank
_ Gas Piping
_ Shutters
_ Windows/Doors
Electric _ Plumbing
_ Sprinklers
_ Generator
_ Roof Pitch
Total Sq. Ft of Construction:'
Sq. Ft. of First Floor:
Cost of Construction: $ Z ��. `a
Utilities: —Sewer —Septic
Building Height:
,OWNER/LESSEE:CONTRACTOR:
3
Name
Name
Address:13 �(�i �SG�u- C�&X 17✓
City: State:
Zip Code: Fax:
Name:
Company: Al L Mow
Address: 6 �✓ t"�sy, �c-�
City:
vvt-L
State:
Phone No. 117 Z qIJ Q If G
Zip Code:. 9 ro Fax:
E-Mail:
Fill in fee simple Title Holder on next page (if different '.
Phone No � G % 766 2
E-Mail Elrk 111(eh 2q 7 1p
�o
Svr►Gf i C
from the Owner listed above)
State or County License.CpC 1YS��`fYS
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State: _
Zip: Phone:
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 ermit 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 t our property. A Notice of Commencement m ere orded and posted on the jobsite
before the firs Ins tion. If you intend to obtain financing, co suit with ender or an attorney before
commencing w r r recording vour Notice of Commencemen
_�;K. _�,A /
.
Signature of Ow er/ es ee/Contractor as Agent for Owner
STATE OF FLOkdA
COUNTY OF -' — ! _uo e.
The forgoing instr ment was acknowledged before me
day of 20 by this a
r
(Name of pers acknowledging)
(Signat re of Notary Public- State of Florida )
Personally Known OR Produced Identificatio
Type of Identifca ion
Produced 11 - ,,, .. .
°" ,,, K � Ir Si, NIELSEN
Commission Noc ' _''�`'0.Y�°° Co' mission N FF 115637
My Commission Expires
REVIEWS I FRONT ZONING SUPEERV17
COUNTER REVIEW REVIEW
n�
I
Signature ol C tract r/License"Holder
STATE OF FLORIDA
COUNTY OF
The for oing instrument was acknowledged before me
this Aday of _/ .W . 20,LtZ by
(Name•of person acknowledging)
(Sign at dra of No ary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identificatio
Produced
KAREN S. NIELSEN
Commission No. =r Q6(5efflJio6 S FF 115637
RO My Commission Expires
June 12;•2'018
REPLAV EW, VEGETATIEVI WON I.. EV EWLE' I MREVIEWVE
DATE
RECEIVED
DATE
COMPLETED ��