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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICA LE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 1� Permit Number: RECEIVED 0 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: To Select from dropbox, click arrow at the end of line S� PR®POSED IM`PR® /EMENT L®CATI To Address: Adin -A Legal Description: Property Tax ID#: a' �oIs. o NO; - C)C0 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED @=)M= OF WORK: e- / s'/`' ° _ fir' � - C®NSTR CTI®N IN:FOR�M:ATI:ON: Additional work toe e orme under this permit-check a appy: HVAC Ei Gas Tank []Gas Piping _Shutters a Windows/Doors Electric 0 Plumbing Sprinklers Generator Roof Roof pitch Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ 3�4-�a Utilities: Sewer Septic Building Height: ©EER LE�SS'fE: C®NTRACT©R: Name ��2�\_�''. t Name: Address: ( � Gt ) (e Company: ` City: - 1 State:_ Address: Zip Code: 7 Fax: City: State: Phone No. J` -204" Zip Code: Fax: E-Mail: Phone No. Fill in fee simple Title Holder on next page(if different E-Mail: from the Owner listed above) State or County License: If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LI,EMLAIN 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: 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 concurfency 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' nd to obtain financing, consult with lender or an attorney before commencing work or recording our Notice of Commencement. s tgnatu)rdof Own r/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF '-'�k. `-%) COUNTY OF The fRrgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this_� day of 20 aby this_day of 20 by Q •n�a, c V`n�,x� 5 (Name of person ac^nowledging) (Name of person acknowledging) (Signature of Notary Public-S to of Florida) (Signature of Notary Public-State of Florida) Personally Known1���� e Personally Known OR Produced Identification Type of Identificatio PFd WEA .WYIiiRIEGIVENS 15 Type of Identification Produced Y COMMISSION#GG 022023 Commission No. e5�o PIRE�PA¢ymber16,2020 Commission No. (Seal) •.,;off F P onded Thru Notary Public Underwriters t Revised 07/15/2014 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS