HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE. INFO II�ALIST COMPLdWOR APPLICATION TO BE ACCEPTED (�/ �/
Date: I RECEIa ED Permit Number: L ! � � — &H06
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:
Address: ` O o Ni
OCT 1 8 2017 r
E yIITTI 'amit
I
ski SCANNED pplication
BY
St -Luce Co n
Commercial ry Residential
WY
Legal Description:
ir1'►�lpa�.:of:r_`s:uf�:���.�+'_�7_�i`�"ac�C ��:c _e,
• i 62
Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side:
t ! Re-V S cO
q (u [�Mc (tc u✓
n L) k
_ Gas Tank
Electric! _ Plumbing
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Total Sq`. Et.of'Construction:
Cost of Construction: $ 00
, . to:(
Carl
Left Side:
JCI I I IIL - u 1ULN GILD IGL 0pf
_ Gas Piping j u
_Sprinklers (:
Sq. Ft: of.Fi
Utilities: Sew
Name 4- S �UJ-•FpfS
Address: 3 100 R kl y R WY
City: -POr,a= Pi&'rC -State:��
Zip Code: ti g S i Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Ownelisted above)
Name:
elr tJ (rn ,
Floor:
er _Septic
Block No.
Company:
\ W"A04:
Address: _ d O L{ Fn rn 4-0.neaa- A V e
City: `-b r'I' � ierc.e State: PL
Zip Code: 3L-I 4 LI 7 Fax:
Phone No. 7-7z. — 11 ?�— Osoo
E-Mail: W N`&\ U t 2 ; nC �_ ko I, Cr,
State or County License:
If value of construction is 2500 or more, a RECORDED Notice, of Commencement is required.
DESIGNER/ENGINEER: —Not Applicable..
, MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip': Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY:' Applicable
Name:
_Not
Name:
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 bylaws
rules, 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 obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
rM�rw
Signature of Owner/ Agent/ Le see y ®m
ignature of Contractor/Lice6se Holder tWy� qq I
FL®o
STATE OF FLORIDA � LL
J a N E
TATE OF FLORIDA 099 g
COUNTY OF
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OUNTY OF q' �kc;e O z
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The forgoing instrument was acknowledged before m 3 m m
he forgoing instrument was acknowledged before e-1 ti t S
w
this 16 day of Oc-to bec- 20� by �, LL
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his 6 da of dGi a i > fA z
L Y be 20� by W
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(Name of person acknowledging) '•'"'
(Name of person acknowledging)
i a -
(Signature of W6tary Public- State of Florida) J,;(Signature
of No ry Public- State'of Florida)
Personally Known ✓ OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification Produced
Type of Identification Produced
Commission No. FF'01&403 (Seal)
Commission No. U0 6403 (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014