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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED \ Date: 15 log I 12, Permit Number: RECEIVED MAY 04 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: PROPOSED MOURN UEMENT MORE ION: Address:*10 P SA:a Glnyew )r !ZA Lucid f=' L �4q 9-t Legal Description: Property Tax ID#: l� � O'— C C) 0o 6 — Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: TALLED DE�-SC �IPTION OF WORK: tri Wub C ► dv A , C©NSTRUCTI.O.N I�NF©RMANIS Additional work to be pe orme un er this permit-check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors _Electric _Plumbing r _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: I 5 6 Sq. Ft.of First Floor: Cost of Construction:$ �-I.(n�I`� Utilities: —Sewer —Septic Building Height: OWN! R 1%100 E4 C®NTRA TOR: Name 4 N4 Name:. AddressAt"LD ESA N Company: City:.. , (J C_SP State: Address: Zip Code: '14 Q�'� Fax: City: State: Phone No. �`l7Aq at 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 CONSTRU TJIRX L1EN LAWIN1=®RMATI®N: 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 recording our Notice of Commencement. Signature-of=Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF S ac. t-U CN-P, COUNTY OF The forgoing instrument was acknowledgedbefore me The forgoing instrument was acknowledged before me this�day of °��b 201) by this day of 20_ by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Pub. -State of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification 4 Type of Identification Produced o UEANNAMARIE GIVENS Produced co MM ON#GG 0220 0 Commission No. PRES:D �9We u, erwf Commission No. (Seal) d btu Not REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE ;COMPLETED ev. i