HomeMy WebLinkAboutBUILDING PERMIT APPLICATION 1-18-18All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
�PANNEV
BY JAN 18 2018
IN,
9f66A1d,1,WPyern1 itTAPP&
I � I
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
NP VEMFN 10 PROPOSED I RO T CAT1OA';:"
Legal Description:
Commercial Residential'
TP_Mr6- I7&X OE PqRCFL -3M75-L-00_'4-
o e.Lot No.
Site Plan Name: I Block No.
Project Name:
Setbacks04YRig -- !-�7;vht.05't
DETAILED DESCRIPTION,OFWORK:,',`
c
UCT ION,INFOR,
ION
�itloddnai work to be pertormed under this
permit — c 'eck
all that apply:
—Mechanical Gas Tank
Gas Piping
Shutters
Windows/Doors
— Electric Plumbing
Sprinklers
Generator
Roof Pitch
CT,7p '��$kf; ' struction:
Sq. Ft. of First Floor:
b Utilities:
S�ti7 o
Building Height:
—Sewer —Septic
'0WOER L,E$,S
ONTR� CTOR;,
F) m ri—
Name:
ddress: 38.1 T196F16qk ZL4F_5 IR
Company:
?- 01
'ity: 7 State: FL
Address:
Zip C6de: 3119 9 g2 — Fax:
City: State:
hone No. 1,2 — 51—
YtL= A
Zip Code: Fax:
i,Phone
!'I&H M a i 1: I cA
No
ill4p Jeejzsimple Title Holder on next page ( if different
iE-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.
I
DESIGNER/ENGINEER:
Name:_
Address:
City:
Zip:
Phone
Not Applicable
State:
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 mpy 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 recordingAur Notice of Commencement.
of Own_er7 Lessee/Co
STATE OF FLORIDA ,
COUNTY OF -:5A
for Owner
The for oing instr ment was acknowledged efore me
this \� day of�a►� , 20�'by
L''. a r j, \ 1:5�ye we 4t_��
(Name of person acknowledging)
(Signature of Notary P blic- State' of Florida )
Personally Known OR Produced Identification
Type of Identification . �.� 1.'SS ° —
Produced t}PINAMARIEGNENS 4
Si? •' MY COMMISs N # GG 0220
EXPIRES: De�?Qbe�r�16, 2020
�F
Commission No. 1� ThruNota P6ih�bnderm"U"S ,
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of , 20_ by
(Name of person acknowledging )
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced
Commission No.
(Seal)
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Rev. 7/2014