HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
I Date: NNED
I Permit Number: I -Q o I
WA
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
0
Building
MOW
Permit Application JAN 2 5 2018
Commercial Residential
PERMIT APPLICATION FOR.:
,P PW 'O�
NP
Address: cc -
Legal Description:
Property Tax ID #: c2ogg 7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
• W Kkj�A-) K I I V rhj a szj 'r 1 9 1 1
Additional work to be pertormecl under this permit— cnec
'Mechanical Gas Tank Gas Piping
Eldttric Plumbing Sprinklers
Total'Sq. Ft'6f 'Construction:
Cost of Construction: $
uti
Name 3CIC>aL A4e- 0 (-Ar, 6 :± r unail
Address:—Q 0 Sre-
City: —&c 4 2z,--t-0JY State:
Zip Code: Fax:
Phone No.
E-Mail:
Fill in, fee simple Title Holder on next page ( if different
from the Owner listed above) -
all,that apply:
,,Shutters WincloWs/Doors
-Generator Roof Pitch
sq: Ft.-.--6f.First Floor: —X3-7 9
S: —Sewer _Septic Building Height:
Name: t@ N QW%'
Company:_ e,,,)
Address: 31 '74- �tj sink 6T—
City: - ( ry� cal� - State:
Zip Code: 9d0 Fax%
Phone No 77 - I 8'c/ V
E-Mail Ae,,,ncilp I'l,"ei-J
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicablelt,,,�,
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 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 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.
Signaturl-of Owner/ Lessee/Contractor asAgent-f'P- ""`
STATE OF FLORIDA�79,�
COUNTY OF 9Cf%V
The forgoing instr ent was acknowledged—lalwSh
this day of 20 m2Wn' )Vcw(Name of person acknowledging)
(Signature of Nttry Public- State of FloFda )
Personally Known /OR Produced Identification
Type of Identification
Produced
Commission'No. (Seal)
,Signature-ldf'Contractop/License Holder'
STATE -OF FLORI
>
COUNTY OF
Co
cc ^N g
_sp2 a
d
The for ing inst ent was acknowledge¢ a
3pday
Wn
this of 20%�b
s 2
Der) n i e, N
�iW o
m
(Name of person acknowledging)
c
(Signature of Notary&6blic- State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced
Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED