HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr-I
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date. �' !♦�` 17 Permit Number: / ' J �
Building Permit Application
Planning and Development Services MAR 14 2018
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1i 78 Commercial Residential ✓
PERMIT APPLICATION FOR: I ogl- -r-4
PROPtfSED INPR®VEMENT LOCATtO,N.
Address: 405 F-k a-, e I i2 e e :I LIB 9
Legal Description: I w z In C2-tg eLz l F-c-1 h I es —V n ,r-7' - 04- BLI'Z `1A - Lc,T 6r 26 P -3L(Ab->w
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Property Tax ID #: D,9- _ B b- — 6 O 6 Lot No.
Site Plan Name: I Block No.
Project Name:•
Setbacks Front Back: S Right Side:_ Left Side: (�
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411 �NPORMATION:
i-Iona work to be performed under tis permit -c ec .a that apply:
_Mechanical _ Gas Tank I _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing I _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: `?j Sly Pl. Sq. Ft. of First Floor:
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Cost of Construction: $ (3 0. Utilities: _ Sewer _ Septic Building Height:
OWNER�LE=-SSEE:
CONTRA'OR.•
Name W�J r'0 o.i D dam, lAl� i,+T -I Z
Name:
Address: �q JET e-- e i J! r e bM- l
Company:
City: Fo ZZJ PfieRrr- State:9A
Address:
City: State:
Zip Code: Fax: I
Phone No. �`��
Zip Code: Fax:
E-Mail: QAcl'I JR-Pc� (14 1) 'N���
Phone No
E-Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above) I
State or County License
If value of construction is 2500 or more, a RECORD i D Notice of Commencement is required.
J PPL MENTAL CONSTRUCTION LSE W INFORMATION:
DESIGNER/ENGINEER:
_ Not Applicable.)
MORTGAGE COMPANY: _ Not Applicable
Name: Gec-IQL
Name:
Address: 46 C '' N-2ex:T
City: !C)t-- L A -i >
Zip:'�b:�!-) d Phone
N c.-.j yYD;ZZ 0v
Stater
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Address:
City: State:
Zip: Phone:
FEE. SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
I
Address:
City:
I
City:
Zip: Phone:
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 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 obtai o financing, consult with lender or an attorney before
co Mencing work or recording your Notice of Commencement.
i
Si ature of ner/ Lessee/Contractor asAgoi
f
Signature of Contractor/License Holder
-
STATE OF FLORIDA6
STATE OF FLORIDA
COUNTY OF
COUNTY'OF
The forg ing instrument was acknowledg eforeIx
day 20 by
The forgoing instrument was acknowledged before me
day 20_ by
this of Zzh A
this of
�N90
(Narr1e of person acknowledging)
��
(Name of person acknowledging)
� N
Signature otary Public- State of F rida V I /
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Id ti io `,�/Y
Type of Identification
Produced (/� I',
Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVI
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
/
COMPLETED
Rev. 712014I
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