HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1a. la- Y7 Permit Number:
Cr ii v7 '
s_ Building Permit Application DEC 12 2017
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 =x
PERMIT APPLICATION FOR:
IWiR
Address:%/ l-/!7C-/�(S�a'L/ �4 C&- fd/'f'AeCL'
Legal Description: 1 Jed /�1 /_ ! -I. OeC/14,eK-UIVI lf" ?--Sz 5-Lo7`!J�
�P z��rl0� a7�°�3�
Property Tax ID#: 0�-�0/0 -0,07Y Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Additional worK to be pertormed under tnis permit- cnecK all tnat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof ��Z Pitch
Total Sq. Ft of Construction: 90ML4booli� Sq. Ft. of First Floor.:''.
Cost of Construction: $ Utilities: Sewer Septic Building Height:
/�3-,tea-cr.� , °`" _ _
OWNER/S
C_4Ni`R1«1OR:
Name,
Name:
Company:
Address:%. //E=/ 1_-7A5 6 4 1JG
/�
City: �f / i54�C'G-" State: 914
Zip Code: " 5-/ Fax:
Phone No. 712,?- 6 3 D� 0�'
Address:
City: - State:
Zip Code: Fax:
%Phone No
E-Mail: 1�A-SfO uS G 3 0, 0 ,C& E : Ale
m
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License -
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
r'
SU R PL MEANT L CC3N- R+t1CiIt N aIEN W I
IMA 4N:
DESIGNER/ENGINEER:`
Name:
Address: I
City: I
Zip: Phone I
I
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _
Name:
Address: I
City:
Zip: Phone:
Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
I
City:
Zip: Phone:
I
OWNER/ CONTRACTOR AFFIDVIT:
I certify that no work or installation has c
plication is hereby made to obtain a permit to do the work and installation as indicated.
menced 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 req ested permit, I do hereby agree that'I will, in all respects, perform the work
in accordance with the approved plans, thel 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, fends, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure
improvements to your property. A P
before the first inspection. If you inl
commencing work or recording you
P Record a Notice of Commencement may result in your paying twice for
)tice of Commencement must be recorded and posted on the jobsite
end to obtain financing, consult with lender or an attorney before
Notice of Commencement.
Sig ture of'`OW r Lessee/Contractor as
v. ,fir*
Agent! for Owned
Signature of Contractor/License Holder
——`°
STATE OF FLORIDA
X.
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STATE OF FLORIDA
COUNTY OF
m°<
COUNTY OF"
z in-� nr
beforg 66 i I
_ '
The fopiping instru t was acknowledgGtl
/1
The forgoing instrument was acknowledged before me
this ay of 20
bye _
1 � � � wY h
this day of 20 b
Y Y
J o n
T TJ
n UA
Name of person making statement.
Namd of person making statement.
I N
Personally Known OR Produced IdentificationY
Personally Known OR Produced Identification
Type of Identificat on
Type of Identification
Produced ��
Produced
(Signature of Notary P ic- State of Florid)
(Signature of Notary Public- State of Florida )
Commission No. (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. 8/2/17