HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO M` U�T}BE COMPLETED FOR APPLICATION TO BE ACCEPTED — ✓J
Date: " ` Permit Number:
C -2- f D
DEC 18 2017
. .. ..... H. s .,.._ . 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: . '_YHt- D
I� oposi=D iNPROVEM,ENr N... 1
Address: /81J to Z4) YJ% a0l�� Dz
Legal Description: C > -5Zt) ��' z
Property TaxlD#:-5-001 —OddLot No.
Site Plan Name: `7 / � Block No.
Project Name:
r
Setbacks Front LJI Back: Right Side: Left Side:
Additional work to be pertormed under this permit— checK all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: 7
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic
Windows/Doors
Roof Pitch
Building Height:
OWNERJLESSEE.
CONTRACTOR R=R
Name cJIL�.
Name: 5= : L�1{i�li'1
Address: / 19d diJ611553 431/6' e,
t
Company%P.j
.
City: �� !tam — State: `7L
Address,"
Zip Code: S��Z�' 2— Fax:
City: State:
Phone No. 77Z—'10-31 �
Zip Code: Fax:
E-Mail: O5'e_4 lra e_,e Lid ,ASS - jJc ll
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State or County License ,
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
it
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: -
OWNER/ CONTRACTOR AFFIDVIT:
I certify that no work or installation has c
MORTGAGE COMPANY:
Name:
Address.
City:
Zip: Phone:
Not Applicable
State:
Applicable I BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
flication is hereby made to obtain a'permit to do the work and installation as indicated.
nenced prior to the issuance of a permit.
St. Lucie County makes no representation tliat is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable HoQ Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Oi ners 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 tb 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 inspectiggq. If you intend to obtain financing, consult with lender or an attorney before
commencing work or rAcording voun Notice of Commencement.
I
Sign t f w er/ Lessee/Contractor as
Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledg
d before me
The forgoing instrument was acknowledged before me
this day of G 20
by
this day of 20_ by
(Name of perso cknowl dging)
(Name of person acknowledging)
L
(Signature of Notary Public- State of Florida)
°O
Signature of Notary Public- State of Florida )
Personally Known
' ti n
Personally Known OR Produced Identification
Type of Identificatio iS`; "V'••,, SCOTTANDERSON
Type of Identification
Produced /33 D. y�R��Oublic
- State of Florida
Produced
omrt�ission
Commission No. ,''•. osf do My com
mpWt1ionai
I
N FF 227308
es Ma 20, 2019
y
Notary Assn.
Commission No. )
(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVI
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. 7/ 2014