HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �'�� v� Permit Number: /n
RECEIVED,
Building Permit Application
Planning and Development Services JAN 2'7 2017
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:
PROPO-'E1D
11119SAM®1/EMENT LOCATION:
Address: 05 RiAu% l:'IZ - $�-
Legal Description:
Property Tax ID#: JYo2-(#1O- 01'2,1-Udy-y Lot No.
Site Plan Name: Block No.
Project Name: d X1718 �y&1- &STI-AV
Setbacks Front Back: Right Side: Left Side:
0MOLM 0E3-MMM, COP WOR
d !Ly EE12 ZL5
CONS R� CTtO INFORMATIO
lwditional work to be pertormed uncler this permit-c ec a that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ 1:300.oa Utilities: —Sewer _Septic Building Height:
CIONRACT@f
Name c Zn1Wf- Name:
Address: O3 of Company:
City: 'FT &- State: % Address:
Zip Code: `3�eJ5Z Fax: City: State:
Phone No.�f bj-P Z-Y7'f D Zip Code: Fax:
E-Mail: Tu 004jU� q(o_�AjAJL-CGw Phone No
Fill in fee simple Title Holder on next 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.
5UP'P EMENTA C*ON5TRUCTION LIEN LAW INFORMATION:
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 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
commMcing work or recording our Notice of Commencement.
gnat a ner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE FLORIDA _ TATE OF FLORIDA
ire:*':�o.;
COUNTY OF OUNTY OF
The forgoing instr ent was acknowledged before me he forgoing instrument was acknowledged before me
thisday of 20Z7by his day of 20_ by
x�a
MEnU
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c.
( ame of person acknowledging) 12W
Name of person acknowledging)
31
(Signature of N ry Public-State of Florid ) Signature of Notary Public-State of Florida)
Personally Known OR Produced Identificatici Personally Known OR Produced Identification
Type of Identificati0 Type of Identification
Produced r. C✓ Produced
Commission No. (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.772014