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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r� Date: 1?= Permit Number: / ��J� 9 RECEIVED Building Permit Application p, Planning and Development Services MAR 2 0 2017 Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 l� Phone: (772)46211553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATIQN Address: 1/5 , /4 E t'E PP- Legal P- Legal Description: Property Tax ID#: ®- ©o—n o 0 - C? Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: CONSTRUCTION]N FORMATION Additional work to fIGasTank orme un ert ispermit-c ec a appy: HVAC ❑Gas Piping In Shutters ❑Windows/Doors ❑Electric Plumbing []Sprinklers ❑ ❑ Roof Roof pitch Total Sq. Ft of Construction: S Ft.of First Floor: Cost of Construction:$ 79. 010 Utilities:Sewer❑Septic Building Height: I OWNER/LESSEE CONTRACTOR Name Enw AA--f) a Ik/-l:P_ `��2A�l Name: lkkG &L+J (tj Address: tl I.( (l l E Company: 'Sort 1&(_ ( ,-J otPP/'a2_ City: fr `�, �l1�C� State: (- Address: 7-Zbo -7D Avk- Zip Code: 3 C) Fax: City: f0f L dL Statela. L Phone No. `� Z. )�j-1�1.� Zip Code: 33l Fax: QSL(-ST7. ZSI 3 E-Mail: Phone No. 15-4" S'_7-7 .9 qy Fill in fee simple Title Holder on next page(if different E-Mail: from the Owner listed above) State or County License: CFC .142-7 971 If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTLON ,LIEN LAW INFORMATION; DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY:f _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: 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 inte�oo obtain financing, consult with lender or an attorney before commencing work gr wcordingopf,Notice of Commencement. r s Signature of O ner/Lessee/ Signat&6 of Contractor/License Holder STATE OF FLORIDAr STATE OF FLORIDA COUNTY OF L.tiLGp (5 COUNTY OF The fo ing ins% u ent was acknowledged before me The forgoing instrument was acknowledged before me this day of PA C-C� 20 0 by this day of M9r�, 20 by --LL, �6r& Qtr�C C� �C / l G—(J r (N me of person acknowledging) ( ame of person acknowledging atu a o Publickstate of Florida) gna ur f Notary Pu lic-State of Florida) Personally Known L—�OR Produc .doentification Personally Known OR Produced Identific tion Type of Identification Produce �-'' ;01 Type of Identificatii n6 Produced *";!!", Fw'IF Ti 1 19 _24,21i ,fg:August Commission No 01"voeu AAtq�C�lC Commission No. 9ad9atNota�Y , '9rFOFf�d' iripF � Revised 07/15/2014 _ + 1*16;Cpc,L: REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS