HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �—�-t7 Permit Number: I I 4 ^ 4 I
Building Permit Application
JAN 0 9 2017
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: �PMo�i fi8t�
PRC)'P®SED INIPROUEMENT LOCATIQN:
Address: 70 /I1e* eS 3/v Te-v7se4 Aa C4, /c. 3 9 7
Legal Description: 2 of t l4»/ 1h C 376y-,2 7/
Property Tax ID#: `/ 5-o 5-01 - 0,9- TO -000-0 Lot No. 70
Site Plan Name: /y-7YAT Block No.
Project Name: lot 70
Setbacks Front Back. Right Side: Left Side':
DET�At�LED DE�SCR+I'PTION OF WORK: NM
! O�' e fe e/-201rh-o r) an t-e tw o va l o l , Y sY' roo,/ l �o m e
o C/rr� �0//4Gt 1'Y�DIl9
C®N5TR+UCTIO'N I�NF®R11t�lAT'I®'N:
itiona work to be pertormed uncier this-permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: ol 7 Y Sq. Ft.of First Floor: 617F
Cost of Construction: $ 1'700.00 Utilities: Sewer _Septic Building Height:
O�WNIER/tLE-�SS$
Name 0r741 d' Lv el h 9. /41,7,-f4m0,-e :Name`
Address: y8. S T Lu 4 eS 4� Company:%�qar4 5,��>`� /3 o6�i7� Svc.:Z•� c
City: j�-Ce wi -71-h ct L d 4 eS State: QW. -Address: d6, .E S,0e icer 5
Zip Code: 11-!?/ yi3S- Fax: City: SnS-e,7 ch State: /C1.
Phone No. 77.2 -23 7 - Yf 97 zip Code: -?"57 Fax: 772-.2,7,2—.21,71
E-Mail: Phone No 772- z60- 3 7/s
Fill in fee simple Title Holder on next page (if different E-Mail in S1"i 7A 4,0 G G y4`ia0 -Corte
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTR+IJCl"I�N L.I'EN LAW IINIF®RMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not A plicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applic BONDING COMPANY: Not Applicable
Name: ame:
Address: A s:
City: City:
Zip: one: Zip: Phone:
I
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 thepermit 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 oprecording yoWNotice of Commencement.
Signature.of Owner/Lessee/Agent. Signature of Contractor/License Holder
STATE OF FILA . STATE OF FLO A
COUNTY OF (�,(h n COUNTY OF Vy la + n
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledgMy
fore me
this�day of .�� , 20ff by this__ day of ,�Qi'i uaiy 20
Nam &4(A0 �1,1
(Name of person acknowledging) (Name of person acknowledging)
1,)&W, �4111vw
(Signat a of Notary bli -State of Florida ) (Sign tur of Notary P bli -State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification t'
Type of Identification Type of Iden 'ficatipn
Produced �L Virginia J oduced �. FR Virginia Jayne
+� NOTARY P LPA (VOTARY P LI
Commission No. �f. STATE OF ORI mmission No. q2A 326 STATE OF FL DA
Canm#FF92 3ftg Canrrx#FF9213
Expires 9/2 J2019 Expires 912X2 19
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014