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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n Date:�_ j _�T'f _ Permit Number:_] ©'7i7 � 7 �i r, Building Permit Application APR 21 2017 Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce-FL 34982 - - -- Phone: Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: DIM Address: 1 I J 4:::WT L Legal Description: Property Tax ID#: Lot No. Site Plan Name: CC ` Block No. Project Name: 1�� � � r 1� Setbacks Front Back: Right Side: Left Side: 121,1112 'Q01113,111, lg I I P2,21 I WTI ��W� 4. Additional wor to be performed under this permit–check all that appy: —Mechanical —Gas Tank —Gas Piping —Shutters' =Windows/Doors'; —Electric —Plumbing —Sprinklers —Generator Roof Pitch Total Sq. Ft of Constructions/: Sq. Ft.of First Floor:. - Cost of Construction:$ c�C� Utilities: Sewer _Septic Building Height: Name a Name: Address: Company: tt City: I , Stag._ Address: Zip Code: Fax: City: State: Phone No. Zip Code: Fax: E-Mail: — , Phone No Fill in fee simple Title Holder on next page(if d' E-Mail from the Owner listed above) Y 1 State or County License If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. ow - Y 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: ddress:--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 gran ting`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. Sigof;Qwne1/�t essee/Contractor as Agent for �r;.�oj Signature of Contractor/License Holder STATE OF FLORI - o; �o STATE OF FLORIDA COUNTY OF COUNTY OF 0 11 The f rgoing instruym�ent was acknowledged before �� The forgoing instrument was acknowledged before me this day of (�t% .20 1-7 by. WJ1 this day of ,20_ by (Name ofperson acknowledging) (Name of person acknowledging) (Signature of tary Public-State of FI rids) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification / Personally Known OR Produced Identification Type of Ide i ' 'onn Type of Identification Produced • _,O C . Produced Commission No (Seal) Commission No. (Seal) r REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW 'REVIEW REVIEW .. REVIEW DATE RECEIVED DATE COMPLETED ev. 7/2014