HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO'MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �"/ -� Permit Number:
RECEIVED
Building Permit Application JAN 19 2017
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:
PRQPOSE�D INPROVEMiE T LOCATION:
Address: 3 �� ltk �7 �G ��✓ ?j�{gC�Z
Legal Description: (i)Krr1-' 133 I-r ,�IE S 213,-7
(�S f(o qN-h
Property Tax ID#: `'flo &,91 'grog om(5 Lot No.
G
Site Plan Name: kyw,W� Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D£T I ED D SC �IPTION O WORK.
5T i J6- Ptl _ 0 L tJ 5 d1 LA_,, IM.OG2 if LEYn f 3
JZ
J"" 0�� /,N 'rLA-L— AN L 1 t Z P c �C. k 419-00-
CONSTRUCTION INFORMATION
M-tional worK to De pe orme un er t is permit-c ec a tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: 1-700 Sq. Ft.of First Floor:
Cost of Construction: $ oco`� Utilities: —Sewer —Septic Building Height:
OW ER/LE�S�SEE: CONTRALTO
Name_ I p S Name: e S 7�GN
Address:
6'1 03 JAAel.V IL.. V_t) Company: ,��6-ZLA.
City: pg�: CE State:�L Address: K
Zip Code: Mq$Z Fax: City: 1� PCc�� State:
Phone No. -)12. Zi g Zip Code: 3 cf 9 Y 2 Fax:
E-Mail: Phone No 77?% 766 ''8PV
Fill in fee simple Title Holder on next page (if different E-Mail 6,y--52LV � P-e� ! &totl , ("n",
from the Owner listed above) State or County License' G��,SS' 1zq
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPL ENTAL CONSTRUCTION LIEN LAW INFORMAT ®�N:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:_PA-ave-z,1 l�pc�tt/v�lxJ Name:
Address: Address:
City: p5 State: -Z City: State:
Zip: �2' LfT,5 Z Phone T(�,��p�j 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 County makes no representation that is granting a permit will authorize the permit holder tp 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 yo pro erty. A Notice of Commencement must be recorded c]'posted on the jobsite
before the first in a you intend to obtain financing, consult with le r r an attorney before
commencingw k o recor in our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature o_Contractor/License o er
STATE OF FLORIDA _ STATE OF FLORIDA
COUNTY OF COUNTY-"OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20_ by this day of ,20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-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. (Seall
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW. REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.