Loading...
HomeMy WebLinkAboutBuilding Permit Application 4 ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 3 !, Permit Number: 0= N—MW p =- RECEIVrD MAR 2 3 2017 Building Permit Application 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: Window/door PFt"OPQSED INPROUEMENT LOATI( N; Address: I U0- 00-t'( I' Pi ems,. ,-G 3 L1 Tk2 Legal Description: TALOA `ul E51'5 —U n.itD6 14C 23 1--o !3 I N Property Tax ID#: 3 yo 7 — �Q — ( ff2— ©OD— Lot No. 3 /1e_1 Site Plan Name: -r Block No. 23 Project Name: trlJd IA/i Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION-`OF WORK: 11 CONS1'RUCT1,01U INFORMATION Additional wor<to be erformed under tispermit—check all appy: HVAC Gas Tank E]Gas Piping _Shutters Windows/Doors 11 Electric ❑ Plumbing Sprinklers ❑Generator ❑ Roof Total Sq. Ft of Construction: S Ft.of First Floor: Cost of Construction:$� Utilities:[]Sewer Septic Building Height: OWNERJLESSEE CONTRACTOR: ,:.. Name L r }- Name a Address:_ IZ, Company: City: 6a Qi_lce'Q State:LL Address: Flk _ ftprwomed Mott 30"$1111142 51 Zip Code: //y Fax: City: State: Phone No. ( � 7i r'i/�/_$s"O/ Zip Code: Laucl@ as eo 331 E-Mail: Phone No. y 'WAr_ Fill in fee simple Title Holder on next page(if different E-Mail: 1 from the Owner listed above) State or County License:(�7C �q� If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. n SUPR"LEMENTAL CONSTRUCTION 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 commencing work or recording our Notice of Commencement. Si nature of Owner/Agent/Lessee Sig ture of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF !�� CWG.L COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this 1 day of 13 200 by this—/--day of_/�a/GLI 200 by 1'cw S'F G,Ad (Name of person acknowl gin (Name of rso ack owledging) PPQS�aG�,O ,L�, Psso (Signature of Notary Public-State of Florida) (Signa of otary Public-St of,FJpn ac)° Personally Kno P�rgd J�r�yf iNG Personally I<no n.� R�.� �er> e on Type of Identifi `�ced A Type of Identifi tion Produc s I'� � I'�.SraTe cF.�` f's�9 2.2017 Commission No. '` ` a ' EXPIREj36 `y) Commission No. (Seal) B Tbt?` FioridaNOWY ervice.com Revised 07/15/2014 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED