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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c� Date:1�` 1 Permit Number: r a RECEIVED JUN 0 91017 Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 i Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential Ca PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED_IMPROVEMENT LOCATION Address: O C.e, O c Legal Description: Seo a"AsCoto 'h iu 7. 0I PropertyTax ID#: (SdoZ'� ©Oa2S1"OOO-� Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: .DETAI,(:EDbESCRIPTLON OF WORK c- 0(o (��� dor ��{z� Corr er- 2.� � �S' sea- .)NAIIG610 , FFMNY P 431 k w -77 CONSTRUCTION'INFORMATION: Additional work toe e orme under t is permit-c ec a appy: HVAC 11 Gas Tank ❑Gas Piping _Shutters Q Windows/Doors FlElectric F-1 Plumbing Sprinklers E]Generator 1:1 Roof Roof pitch Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ Q s-0.C :1 Utilities: Sewer ElSeptic Building Height: OWNERAESSEE: CONTRACTOR: Name V G N 2,0 le Name:_Sor1-,vLej1 T. ✓U r AC4, Address: 10 OqL( S. t)ceevij D f. Ibi'3- L(O( Company: X11 vinnIm— `i I L City:_-�Ptnseo Rey_k State:F. Address: S. Marlke_k ave, Zip Code: Fax: City: F+ . (V(&te_- State: (f:--c' Phone No. Zip Code:�{gZ-e, Fax: 77A-�(6S E-Mail: Phone N,,''o.. 7��- LIE-106 Fill in fee simple Title Holder on next page(if different E-Mail: M ytty' oa'_Pe6ki f r R,140 r'Q'I -(&9 V.-) from the Owner listed above) State or County License: CAC03 966C( If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. -SUPPLEMENTALCONSTRUCTION LIEN'LAW-INFQRMATIQN DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable J _ 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~ �/�� s Signature of Owner/Lessee/Contractor as Agent for Owner Sig ure of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF -5y L, C_'P COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this_,9-41day of 20,,7 by this_"day of 20/ by (Name of person acknowledging) (Name of person acknowledging) S gnature of Notary Public-State of Florida) gnature of Nota Public-State of Florida) o\`��vg09g94461E1il�O�f> Personally Known_ -- OR Produced Ikli°tifi caYtoRN. nEPersonally Known ,--� OR Produced Identification T o� �y G01� 3s ype of Identification Produced_ 9 9-;,Type of Identification Produced Commission No. Ff'e7sr�s9 �I) �• �• I-ommissionNo._Fr_o�.�2� Revised 07/15/2014 ����i/s�eATE�OF•F��F� y� o'd oF�og2� 6,9 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATU , AIE° VE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW EW DATE COMPLETE INITIALS