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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: ! t ? y'C FE" D aw B 1'1g`P£�f"mitt Ap$ica �t3�9 MAR 2 2 2017 Planning and Development Services pEF;S�ii I Tii�;G Building and Code Regulation Division St. Lucie County FL 2300 Virginia Avenue,Fort Pierce FL 34982 Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: PROPOSED IMPROVEMENT LOCATION _ :,„ - "= - Address: N Y �. Legal Description: \_`) rx ©,e Property Tax ID#: _�2�� `� [3� t Q Ej� � =010) Lot No. _ Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK - ?�e-- Zco ��� Si-ci asyt�s J CONSTRUCTION INFORMATION - - itiona wor to a pe orme - un ert is permit-c ec a 't atapp y: _HVAC _Gas Tank _Gas Piping _Shutters indows/Doors _Electric _Plumbing _Sprinklers _Generator _Roof 1 I —Roof pitch Total Sq.Ft of Construction:?n 14 0 1�,9- Sq.Ft.of First Floor: Cost of Construction:$ 9 2 y y _ Utilities: _Sewer _Septic Building Height: OWNER/LESSEE CONTI7ACTOR Name •A Name: {J"t e;"C 231 Address: 4� c�`� 4U L, Company to City:�,A Pic\0 State: Address:411a Zip Code: Fax: City: a `XI State: .,Phone ft. 1 /Jq •Zip.Code:4?(/Q '��_ Fax: E-Mail: Phone No. Q �� Fill in fee simple Title Holder on next page(if different E-Mail: from the Owner listed above) State orCounty License:� C tf_valueofconstruction_is ?SOO-or•more,a.RK0RQFD.Notre4f,�CAmmenCgment.is-rEquirEd,_ SUFPLEMENTat CCaNSTRUCTION LEEN LAIN INFQRMATlON 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: 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 1 will,in all respects,perform the work ire aecordanmwith;the approved,plans,the�Florida.•Building-Codesrand.St.Lucie.-Cotrrtty,Arnendmerrts. 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 cammeric rr wor-k-or-,recordirtour-Notice•of-Commencement. Signa re of ner/Le /Contractor as Agent for Owner Signa re of ntra6inrXicense Holder STATE OF FLORIDA STATE OF FLORIDA CDUNTII O \u s.� e COUNTY Ci- The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this 2--day of 20 Eby this2_1day of L i 4-rCXA` _20M by f5 To --, (Na of person acknowledging) (Name of person acknowledging) J, „ - ignature of Notary Pu c-State of Florida} (Signature of Notary Pub' = #ate of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Produced Type of identification Produced Commission No. A DE L,kBa�Q! VELASCO : Commission No. MADE LUZ VELASCO X_ -!Fm� COMMISSION#GG050399=XR ?M�YvCOpMMIuS��w,i��+yE �fe�n r rrr +�.r . EXPIRES�7Ttlr+rWf GVr f�}60 Revised 07!15/2 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE 'COMPLETE INITIALS