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HomeMy WebLinkAboutBuilding Permit Application (2) All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED F Date: Q - 1 b 1 Permit Number: TT . v. i _ APR 10 2017 Building Permit Application PERMlT!'fNC Planning and Development Services St. Lucie COUnty,FL 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: Address: S on"t b rzc�fl� 21✓� Legal Description: Property Tax ID#: 00 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: a © � 1 WsM" �'�M A1C 1 5\ i �(L�N( vr17► 1+11 a.s P���Eai. l.. �d� x. cir :h .0� - 2 0 Ps l -t�1 -�. C�:��� P� ,a , o•�,� Wft MW j Additional we to a pertormed ,under tis permit-checK all that appy: _Mechanical _Gas Tank _Gbs Pipings _Shutters _711Vindows/Doors Electric _Plumbing _Sprinklers _Generator Roof Pitch Tota lsq. Ft,'of Construction: Sq. Ft.of First Floor: ' _ .� Cost of Construction:$ teaUtilities: —Sewer Septic Building Height: 3 CX 1. ilk Name Name: SICL-UV Address: 1'11-Tg b"OK L,P�� Company: i. City:�o�� tcned State:"5(-- Address: s S Zip Code: V (9 Lf(� Fax: City: 1� State:_,C_'!1__ Phone No. c(uS�(,Oc(- 916:? Zip Code:_ 220 ! Fax: E-Mail:-'Ib(r:v 1...i'S 0 WL- ('V"' Phone No V-T Fill in fee simple Title Holder on next page(if different E-Mail id✓ /,V 19590Q j'pay ZhJ , CANA from the Owner listed above) State or County License If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. 1, 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 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-recordin our Notice of Commencement. Signature ner/Lessee/Contractor as,Agent for Owner Signature ontractor/License Holder %STATE O ORIDA •_. STATE 0 LORIDA COUNTY OF S a �.�Gt C COUNTY OF The for oing instr4nent was acknowledged before me The fo doy�g instru t was ac nowledg d befor this day of 20 by this�Jday of 20 by �.. wdnl7e, rn (Name of person ackn wledgin (Na a person acknowledging) ms m o Un z mac= wzc T (Signatu,e ofNotary Pu lic-State of Florida) (Signature of Vary Public-State of Florida) o Personally Known, OR Produced Identification Personally Kno n OR Produced Identificatio Type of Identific ion Type of Identification , ProducedL Produced EY�L `YP0.YrP Y0. KAREN NIELS s. g ,_ Commission 4 gomgSo No. (Seal) N. Commission No. MY Comiss on JunE Expires 2 01 8 1 , 2 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.7/2014