HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Nj Permit Number:
RECEIVED NOV 18 2016
Building Permit Application
Planning and Development Services
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:
PROTZ ED N�PROUEMENT LOCATION
WN `{N'.
Address: 1— �
Legal Description:
Property Tax ID#: Mp� 1:2— 6 03 62C06 — 200 9 Lot No.(�
Site Plan Name: I d ))0'I �1 ( \ ..5t, Block No.
Project Name: Ca�Y`f
Setbacks Front_ Back: lbb' Right Side: 30 Left Side: —
I,.i . !1 111,11, , «..: rte. lAd
DETAILED ®U310, TION lQF�1NORK:
k
e�
3000
CO' STR'UCTION_IN`FOR ' AyyTIO'N
-,ice u ,R'.^"9a'6�d`n J. ' !1}'s .y.�A'•i� R_O— r WIF
Additionalworkto a performed under this permit—check a that appy:'
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ a�Y >, Utilities: —Sewer _Septic Building Height:
O NICE LESS_EE': k � C NTRACTOR.
aim / .r�� '
Name. Name: O
Address;'15.� .: S:; C� lam—' Company: Piv1C
City: p� State: Address::.
Zip Code*: �/'7 Fax: City: State:
Phone No. 00'73 , 03/R Zip Coder �}' 9 e2- Fax
E-Mail: tVS r [7/. Cron, Phone No c2 C/ V0 /}
Fill in fee simple Title Holder on n&page (if different E-Mail' V arc ?C2]D Qv.'Q to
from the Owner listed above) State or County'Eiense
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU'A'PLEMENTA�L CONSTRUCTION L E�N LAV1/ INFORIVIP►TI ��N':
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: 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 Count 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 obtain financing, consult with lender or an attorney before
commencing work or recordJng your Notice of Commencement.
Signature o wner/Lessee/Contractor as Agent for Owner Signatur of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF�c- \,-Mc- _COUNTY OF Sk, LX3t'%Q_
The fo going instrument was acknowledged before me The forgoing instr me t was acknowledged before me
this day of A%.) 20\5- by this�day of ��� 20%( by
hoa►a`J;Lcz�
(Name of person acknowledging) (Name of person ackno dging)
(Signature of Notary blit-State of Florida) (Signature of Notary blit-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identificatio
Type of Identification Type of Identification
Produced �- me Produced L L 1eG N5
O p1AtlIPR1# COMM1SS10N#GG
Commission No. .,,`1 �� ��te•�2� °,� Commission No. pS: und° ��
.�v,.. C g;0 m �Un iv�d, ora
•i�9.• EyQ1� publi d0 j is Bond N
''•,'< lyowl tied<<�?•`
REVIEWS FR ING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COU ER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 772014