HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �4`' �J(-. 1? Permit Number:
l m--0 40-0
-EVED
Building Permit Application
DEC 15 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
PERMIT APPLICATION FOR
0ROPOSED°INPROV NLaCATION ..
Address: 41//6 --'/// L_ 16JA�.ve— Av fL;R;e ft-C �L acl9.7a
Legal Description• ®Lc;� �- I'Ja riC; �k ,�t' j �(1 �F -cti �"1�'ii-./(-13 -�
PropertyTax ID #: Lot No.
Site Plan Name: Block No.
Project Name: .
Setbacks Front Back: Right Side: Left Side:
Name /emJ (7 )e-om e w r-5
Address:W!t//R "V,.e�Q✓e
city:, - Fr' Re r-c-e StatelL
Zip Code:i 1JLJ S 8 ,?-- Fax:
Phone Noi 73- —Q 7/ 'aLa-s4 O
E-Mail: De- t C_Arr 110 yk 4.0o_._0 -$1
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:_
Company:
Address:
City: State:
Zip Code:
Phone No
E-Mail
State or County License
Fax:
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
- - I , :
SUPPLW�Nit.CQNTRUTICI'i.1N L11CsllVQRMATIQN:
�s '' yx
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not'Ap plicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable' BONDING COMPANY: Not Applicable
Name: Name:
Address: I Address:
City: - City:
Zip: Phone: I Zip: Phone:
I
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 oftthe 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 our Notice of Commencement.
Lessee/Contractor as Agent
for'
Signature of Contractor/License Holder
STATE OF FLORUN
STATE OF FLORIDA
COUNTY OF
"�';°q°"''
COUNTY OF
I re x�
The forgoing instrument was acknowledged of
�by
The forgoing instrument was acknowledged before me
this day of �ti C 20 %
2 ��
this day of 20_ by
(Name of person. acknowledging)
�_�
(Name of person acknowledging)
�N
WO
(Signature of Not Public- State of Flori )
(Signature of Notary Public- State of Florida )
Personally Kn n OR Produced Identification
��
Personally Known OR Produced Identification
Type of Ide tifica o D�
01r-
Type of Identification
Produced
Produced
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
ev. 7/2014