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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: a Permit Number: RECEP.._D MAY 12 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: PROPC SED IN-PRO EIVIENT�LOnCA'TION� r �' ` Address: Legal Description: C ��0�1 Property Tax ID#: 33a'�_�1V�►, 0013 ,Qdd a, Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: D'ETAIIED DESCRI 'TIO'N' OE 1NORK: ,CONSTR,UCl-I0IOW N_FORMATIO'N Additional work to be performed under this permit check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _ElectricPlumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ ?7j Utilities: —Sewer —Septic Building Height: 01INE'R/LESS=nE: �CONTRACT©R: Name _ i oc ��. C r� Name: Ru U Address: c/y L/ fI erCcCompany: City: D ( State: f' Address: /7 �L/'Lir„` . 4(-\, Zip Code: 3-11117 Fax: City: 16� 7 �f I C ('�' 'L Phone No. (U Oji ( 9 �(S State: Zip Code: Y / Fax: E-Mail: Phone No ?e 3 7c) Fill in fee simple Title Holder on next pt age If different from the Owner listed above) State or County LiCense value of construction is 2500 or more,aREC®I�DEONot%ce'll, NO S •PPLEM ENTAL CQ SIT,R!1 Tk®N LIEN LAW 1 Ni FaRM:ATM DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable Name' Name: Address: Address: City: State:i City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: I 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 fans,the Florida Building Codes and St.Lucie County Amendments. The following building ermit plica 'ons are exempt from undergoing a full concurrency revie .room additions, accessory structures wimrr' g po s,fences,walls,signs,screen rooms and accessory uses another non-residential use WARNING TO NE' .Yo -`failure to R ord a Notice of Commencement m�� ,re su 'n you yy�aying twice for improvement to yQ' pr pe y. A o 'ce of Commencement must be redcr'rded� ed an the jobsite before the fi t in p cti you i nd to obtain`financing, consult wit %(en er or, ti attorney before, commenci wor r r din r Notice of Commencement. f/ Signa ur o. Owner/Lessee/Contractor as Agent for Owner Signatdr f on ract &/license Holder C OF FLO ID ST�OF FLORI A C TY OF 't( \� COUNTY OF19 The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this\a day of "M G 20_• by this\gdayof ilvNON ,20t by c (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary blic-State of Florida} (Signature of Notary blic-State of Florida} Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identifiiccatio Produced t- -- Produced \ DLANNAh7ARIE GIVENS ! ���`�rNCMS NAY CommisS10N#oc�NGG JYZO 3 l 3?: �toN#Goo22o Commission No. P1RES:D,es COr(1rI115510h No. rMY Gt� 1g 20 ndevrrite; ;oFR,o on ThruNota a Notary'U"Ir Un:ien+sclera FRD ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE (MANGROVE REVIEWS REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW COUNTER