HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �7 )`7 ` � Permit Number:
S. CI ,®
Building Permit Application JAN 2 4 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:
PROPOSED INP OVEMfNT LOCATION:
Address: I170`0 s �t�G a C4 PS '151419,7
Legal Description: -55 - 7 4 20 Pl.�, I
052-076)0 J„sf ne
Property Tax ID#: L90 T2 Lot No. �_
Site Plan Name: --'5k'4e1 Block No.
Project Name: J in
' S. 7
Setbacks Front �J� Back: Cc-;Ot-)Right Side:_L(� Left Side:�®
FgWfmi01M FiflM OF OR
CONSTRUCTION I 1=0RMA ION:
! ional work to be pe orme un er t is permit—c ec a tat app y:
)(Electric
Mechanical _Gas Tank Gas Piping Shutters Windows/Doors
_Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: B�� Sq. Ft.of First Floor:
Cost of Construction: $ I �yJ� Utilities: _Sewer _Septic Building Height:
OWNER% EiR CONT TOR:
Name "3vt?41ne SiC:c Name:
Address: I I G41 CA • Company:
City: 5L• State:I'J• Address:
Zip code: ✓14a'$7 Z Fax: City: State:
Phone No. '7-7Z .Oq- 71
2D Zip Code: Fax:
E-Mail: A 54 a Phone No
Fill in fee mple Title Holder on Ikext page(if different E-Mail
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 CONSTRU TION LIEN LAW INF®RMATION:
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 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 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 recording our Notice of Commencement.
csi j-tGre of Owner/Lessee/Con for as Agent for 's Signature of Contractor/License Holder
_s it
STATE OF FLORID STATE OF FLORIDA
COUNTY OF a X�> COUNTY OF
2 mgm-
o ms m
The fo�ing instr nt was acknowledged before 55 m The forgoing instrument was acknowledged before me
this day of 20�by Z this day of 20_ by
m N
(Name of person acknowl dgi g) (Name of person acknowledging)
� �
(Signature of No ry Public-State of Florida V (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Ide`nn ' is tion nn.. Type of Identification
Produced cJJ ;moi Produced
Commission o. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. /203.4