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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (Q Date: 4- o. 17 Permit Number: /Jo/ . --� � Wez Li RECEIVE® ` r Building Permit Application APR 2 0 2017 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: To Select from dropbox, click arrow at the end of line RROP. CATION Address: Ava� r e 3 Legal Description: –_S t –3 � I ) C 0 Ad OK 1 -3 - Ko 7) Property Tax ID#: �'f'Q — 70 t ""o0g)–(4 ©(xj=� Lot No. Site Plan Name: �� �P Block No. Project Name: t ~ Setbacks Front Back: Right Side: Left Side: T-- DETAILED DESCR(PTtON OF WORK - CONSTRUCTIOiV INFORI1lIAl'(ON - - itiona workto e e orme un ertpermit–checka that appy: HVAC Gas Tank InGas Piping MGenerator Shutters ❑.Windo s/Doors Electric El Plumbin Sprinklers _ oof, Total Sq.Ft of Construction: S .Ft.of First Floor: Cost of Construction:$ "Q , Utilities: Sewer Septic Building Height: S bWNER/LESSEE _' CONTRACTOR; _ Name lt Name: Address/:° Company: City:_t-oY �I SCP State: ddress: Zip Code: 3 Fax: City: State: Phone No. 7 �..� -7a Zip Code: Fax• E-Mail: Phone No. Fill in fee simple Title Holder on next page(if different E-Mail: _Aq the Owner listed.above) State or County License: If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. JI S:UPP4E- NIALCONST-9 E--tT"L-MT1NFQRW 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 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 orrecording your tice of Commencement. s Signatu(e Awnerl Lessee/Agent Signature of Contract /License Holder otract /L 0 1 STATE OF FLORIDA STATE OF FLORIDA f COUNTY OF COUNTY OF A I& The forgoing instrument was pcknowledged before me The for'go* intrumeptwa k ledged before me t1l ?d4 "c 7' this JC� ay of APZ—t'1 20 -�'y 20 aby �� 114-0 L6� (Name o p rs n ackno,21e ging) (NameVrso acknowrg7in ) (Signa re of otarA(iblit-!�ate of Florida (Sign-Sture(NWu�ic-S of Florida) n Personallyfnow n R Produced Identification Personally nown=OR Produced Identification Type of Identificatlo&roducedType of Identification Produced Commission No. ROY D FR*W�ON Commission No. ROY D FRAWeJqN Floridaotary-Public-State of Florida 019 ,2019 Notary Public-State of orida C'nrnmigs ann OFF I AS I RA Commission#FF1 88186 My Commission Expires Jan. M Commission Expires Jan.8,2019 ix Revised 07/15/ 1 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE =INITIALS