HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETE FOR APPLICATION TO BE ACCEPTED
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Date: - b(;ANNED Permit Number: IID
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.Lucie County
-- Building Permit Application RECEIVED
Planning and Development Services MAY 2 3 2017
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:
PROPO fD IN�PROUEMENT LOCATION:
Address: OZ .� S 2 2 9 f3Y
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Legal Description:
Property Tax ID #: 0 - (a Lot No.
Site Plan Name: Block No.
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Project Name:
Setbacks Front Back: Right Side: Left Side:
DE 4LED DE-SCRLPT ON OF 0 'K:
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CONSTRUCTION INFORMATION:
Mona wor to a pe orme un er t Is permit— c ec a t at app y:
=Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft ofConstruction: - I D. c�7 Sq. Ft. of First Floor: .
Cost of Construct ion:$ Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name to ti �f
Name: _1 cJ i> L`•
nn //
Address:�j�d 'rv" S dDnn �ri6 Y
Company:
City: i 6L State: tip&
Zip Code: JZ Fax:
Address: Z 5� Jl�� i�✓�
City: 3 L- State: -
Phone No. 772- '777- 93 3,q
Zip Code: 34553 Fax:
E-Mail:
Phone No
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail m,
py I?/t(n - �'�I �1 _
State or County License % `� e A151 y eep
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNE ENGINEER: / Not Applicable
Name: J
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address: / S ¢ �of� /
Address:
City: S State:
Zip: 3 Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
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 dwhereby'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 io another non-residential use
WARNING TO OWNER' our failure to Record a Notice of Commencement may result in your paying twice for
improvements to yo roperty. A Notice of Commencement must be recorded and posted on the jobsite
before a first in ection. If you intend to obtain financing, consult with lender or an attorney before
comn-Tencivie work or recordinevour Notice of Commencement.
a ure o ner/ Lessee/C _ _ eto[ as Agent f
SignaAvof Contractor/License Holder
STA OF FLORIDA
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STATF FLORID
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COUNTY OF
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COU OF
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The forgoing instrument was acknowledged efore
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The foWooing ins ument was acknowledged before a
this day of %% fQ/ 20/ by
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this �Sday of 20 % by & � i
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oaQ
1; o ro re
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(Name of person acknowledging)
as 2
(Name of person acknowledging)
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(Signature of N ry Public -State of Florid
(Signature of No VPublic- State of Florida )
Personally Known ' OR Produced Identification
Personally Known ✓/ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/ZU14