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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Dater Permit Number: �1 asp �a cJ -; RECEIVED MAY 10 2017 SAW 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 R'ROPOSED,IMP,RO:VEMENT LOCATION: Address: Legal Description: Property Tax ID#: ����—" 5�2-- Cil?'1�t2 ��(� Z Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: `DETAILED D'EkkIPTION OF WORK: k oAtK (L,�CJL L&-, CONSTRUCTION.INFORMATION':' Additional work to be performed under this permit—check a" tat apply: HVAC Gas Tank []Gas Piping _Shutters ❑Windows/Doors Electric Plumbing Sprinklers Generator Roof Roof pitch Total Sq. Ft of Construction: SFt. of First Floor: Cost of Construction:$ `� Utilities:cn Sewer Septic Building Height: ON ER/LESSE'E CONTRACTOR: V1/ Nameu Name:-5 a Address: 6n Company: (, City: 16/C_Q State:_ Address: � � Zip Code: q 1 Fax: City: eq(�� State: R Phone No. Zip Code: 3� lb/Z Fax: Z— E-Mail: Phone No — 75( Fill in fee simple Title Holder on next page(if different E-Mail: from the Owner listed above) State or County License: _(-j 117 1 QQ4S If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. P SUPPLEMENTAL CONSTRUCTION LIEN LAW 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 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. �\ s Signa Owner/Lesse Contractor as Agent for Owner Signat 're of Contr for License Holder STATE OF FLORIDA STATE OF� IDA COUNTYOF St. Ly COUNTY OF . 11,Uc� The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this VO day of 20Mby this_\P�_day of VIv" 20 AJ_by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Pub' -State of Florida) (Signature of Notary Pu lic-State of Florida ) OR Pr �Bti(t�;� Personally Known OR Prod Personally Know r.• •"'': on Type of Identificat. NS Type of Identific dt€cecm 'C k#000220 9';Po,,;• :December 16,2020 COMtAISSION#GG 022023 ';��•...•P Commission No. ' EXPIRES: hper16,2020 f� Commission No © ThruNotary denvriters 'r• o� Bonded Thru Notary Public Undervr^ters Revised 07/15/2014 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS