HomeMy WebLinkAboutBUILDING PERMIT APPLICATION-
All APPLICABLE INFO MUST BE CONIFLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Numbeir: o . ` -tql 1
SCANNED
Building Permit Application
Planning and Development Services
Buildil"'g and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phoi4+l : (772) 462-1553 Fax: (772) 462-1578 Commercial Residential V
PER'' IT APPLICATION FOR:
P{ �C�POSE.® INlPRQVEME� T LC}GA.TIG�N:
Addre� s:
Legal Description:C,YZ-Evl� h%Rlis-UktT3 6LJ�- J bol 3
Property Tax ID #: ��i )--)C) i o�lm c� - ��9 " U/ ✓ Lot No.
Site Plan�i Name: H9 (P(.D 1rA Loo-y Block No.
Project Name:
Setb��cks Front Back: �_ Right Side: Left Side:
Z. 11 u6n
v�-
Additional work to be pertormed under tnis permit - cneck an tnat apply:
Mechanical, — Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric Plumbing _ Sprinklers _ Generator _ Roof Pitch
d
Total, Sq. Ft of Construction: Sq. Ft. of First Floor:
2ac� Cos „of Construction: $ ,� Utilities: _Sewer _Septic Building Height:
+�RjLE=�SSEE:
CCENTRACT®R:
Name
Address*:
C'I
zip
Phone
b4�7T&rr-1I
14 arme: Z �_
tom a i a , e I c9�t'i.PA1aJ
Address:
City: State4::Z-
Zip Code: -*toi g a Fax:
( Y`� Q &Lky
-Stater
Code: Fax:
No. Sr) d - a/ %
E-1�ail:
Phone No q CA-(91 cp- 1(�
in fee simple Title Holder on next page ( if different
E-Mail
Fill
frlm
the Owner listed above)
State or County License C�
IT va,iue oT construction is 25UU or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:` , _ Not Applicable
Name:
Address:
City:
Zip: Phon
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:_
Address:
City:
Zip:
Phone:
Not Applicable
State:
Not Applicable
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 structl re
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 followingbuilding
g 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. `
Signature of Owner/ LeS;WKOntractor as Agent for Owner
Signature Contractor/Licens
of older i
STATE OF FLORID
COUNTY OF ��t
i1
STATE OF FLORIDA
COUNTY U��
��
OF �rI—
The forgoing instrument was acknowledge before me
-I i —1
The forgoing instrument was acknowledge before me
this day of 20 1 by
this 1 day of 20 IE by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
.•,p• .� ., BREypA ROMERO ZEI.AYA
(Signature of Notary Public r' a
Signature o Notary Pu iG5t.�;pf`�{}{�i�� a
Corr . s or z GG 20i712
,�i 3R_ %7A RJM.;RO Z:.AVA
2
Comm. Expires Apr 18. 2022
�� 9or� Notary Assr.
Commission No. �`'/ F f•2-No(sealkic • Stite r� F,.r;��
C
Commission No. throug� al
' CQ-rr lssior t GG 2017 1
N: Comm• Ex;fires
�"•w�e►�
Asr it, 2022
-
atiori• NotAr; Assr,
REVIEWS
FRONT
ZONING
PLANS
EGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
17 l
Rev. 8/2/17