HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPUCABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTS I
—J
Date: 0 I Ot SCANNED Permit Number: /IOC
BY
• St. Lucie County RECEIVE
Building Permit Application
planning and Development
OCT 13 2017
Dices
Building and Code Regulation Division
2300 V/rginia Avenue, Fort Pierce FL34992
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PRQ (15R 1 MP86VEMIE0T;L`C!£s4T10N.
Address: k t) 'N
Legal Description: `\ t I LYn 'c (4 ?^ �-k�&�
T %300c�
Property Tax ID iF..W2% ) 7 _ 7 //y 000 7 e-7O e9 i Lot No.
Site Plan Name: I
Block No.
Project Name: i
Setbacks Front Back: Right Side: Lek Side: i
taETAILEr))DESCR)P,TJON OF WORK t z-'
u � Tt "• t _. Q *ft� r�ia ... a ,��Y uz�.'Kz
.
1 70 Ur, Vh w od C-P.n c e-
n !
CONS RUCTl- iN ORMATtO t
loons wor to a 110,11M un ermIis�sIpermit—c ec a "
appy:
❑HVAC Gas Tank as Piping Windows/Doors
jj''��_Shutters
[:]Electricp)umbing sprin lers El Generator ®Roof Roof pitch
Total Sq. Ft
of Construction: a �u ..�l.:s�s S Ft. of First Floor: tt "
Cost Construction:$
of tilities:�Sewerosepl Building Height:
OWRJUSSE'"
CPf ITRACTAR,„ f
Name
Name:
Address: �^�.0`t
Company: I
city: 1 -lX State:
Address: i
��(�Al u'�'2�((�
t
Zip Code: Fax: �
City: i
Phone No.=- UL41[o- 2aj` V
State:_
Zip Code: f Fax:
E-Mail:
Phone No.
NII in fee simple Title Holder an next page (if different
E-Mail*, I
from the Owner listed above)
State or Coun Ucensle:
If value of construction Is $2 vv or more, a RECORDED Notice of Commencement Is required.
V
SUPPLEIFrti:NTALCOA757tUCTtONUEEfiAilY3NFORIVIA7jON
DESIGNE GINEER: Not Applicable
Name:
MORTGAGE COMPANY:
Name: i
Address: I
City: I
Zip: Phone:
I
_ Not Applicable
Address:
City: State:_
Zip: Ph o
State:_
FEE SIMPLE TITLE LDER: _Not Applicable
Name:
BONDING COMPANY:
Name:
Address: I
City: I
Zip: Phone:
_Not Applicable
Address:
City:
ZIP: Phone:
OWNER/ ONTRACiOR AFFiDVIT: Application is herebymade to obtains ' permit to io the work and installation as indicated.
I certify that no work or Installation has commenced prior to the Issuance of a permit.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all iespects, perform the work
In accordance with the approved plans, the Florida Building Codes and St. Lucie County Amdndments.
The following building permit applications are exempt from undergoing a full mncurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen moms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may II ult In your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before h� first inspef>)!On. If you intend to obtain financing, consult with lenber or an attomey before
corn
nc ne worWWoF decordine your Notice of Commencement. I
I
ignature bfOwner/Lessee/Conractor as Agent for Owner
Signature of Contractor/Ucense
Holder
STATEOU
STATE OF FL
OLORIDA�� LJ(.J Q_.
COUNTY
OUNTYOFORIDA
before
The forgoing instrumens
Theforg Ing Instrument was acknowledged before me
May f7f ?tOh•p.0 by
this of
was acknowledged me
20_ by
this of .20_0
_day
!I
E
Name of person making statement
Name of person
making statement
Personally Known OR Produced Identification_
Personally Known
E OR Produced Identification_
Type of Ide}�ttttlIfiWtio
Type of Iderdifiration
Producedyt7fl bL
Produced
f
(Signatu% of
akffLjtjie Off
{Signature of Notary Public
-State of FloridaT )
commission
"a
D +"•"•
:ANGEIA SIFER
N' n. sN�EEsg
0.� Sea17
ISSION
Commission No.
(Seal)
G072fp77
EXPIRES Juno 2B, 2a21
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGE7ATI
IN
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
i
DATE
COMPLETED
Rev. 8/2/17