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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST:BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: "aWvyft, Doi -,Oil. Permit Number: / 10' � a-- RECEIVED �� Building Permit Application Planning and Development Services JUN 2 6 2017 Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone.: (772) 462-1553 Fax: (:772) 462-1578 Commercial Residential tK PERMIT APPLICATION FOR: To Select from dropbox, .click arrow:at the end of line OR'O.POSED IMPROVEMENT LOCATION: Address: er e_ - i' Q i''GC' R-- 3`f q 44 9 Legal Description: '�C�D•V1 �e-S0r- e_o0 ���`��ye- 51�� 3�i2 C.0(L X31— Il�l� Property Tax ID#: 1LiI0_ S©Z - 03`7Z - 000 —/ Lot No. Site Plan Name: _51 l wirmow? Block No. Project Name: 5 i I re Y, 6400 t !1 Setbacks Front Back: Right Side: Left Side: DETALED:DESCRIPTIOIV OF -WORK: 1\) S -T- A L, Pr, � ON 0� si X L �j P�a.1) a ►> S Iq u� ems . .CQNSTRUCTION INFORMATION: Aaditional work to e e orme under this permit -check ec a appy: ❑HVAC F Gas Tank. Gas Piping Menerator Shutters Windows/Doors ❑ Electric 0 Plumbing OSprinklers ❑ Roof Roof pitch Total Sq. Ft of Construction: Cost of Construction: $ 3 -7 Gla `"( Z S Ft. of First Floor: _ Utilities: Sewer O Septic Building Height: ®INNER/LESSLE: CONTRACTOR:. ---A A Name O d' Oita Name: YV NY- I Company: _ V'�S-• i c� Address: D0 L! Address: City: - '% Q-►^C'L State: _EL- Zip Code: 3 y�I Fax: L City: F7 - lQ/ Gc� State' FL Phone No. V]7Z-4�69 Zip Code: -3 %05_) Fax: 772-7R4 -)SV E -Mail: Phone No. - - /LS_ 2 ) Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E -Mail: 884-6 e, -i �ie�hu �'Qr si l7C� lY�{i State or County License: o2 If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. ,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 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 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 yo 'sminom'yO , "\(11, Signature df Owner/Lessee/Contractor as STATE OF FLO COUNTY OFS The foging insi his tday o (Name of person ur Notice of Commencement. for Co STATE OF FLORIDA COUNTY OF Ca_ ,J ise Holder rr ledging ) 3 a;: 1 (Name of person acknowledging ) 11 F oA (Signature of Notar V ublic- State of Florida ) Personally Known ✓_�OR Produced Identification Type of Identification Produced Commission No. Revised 07/15/2014 (Seal) (iL/ (Signature of Not Public- State of Florida ) Personally Known / OR Produced Identification Type of Identification Produced Commission No. (Seal) REVIEWS d Xn a z �� The forgoing instr nt was acknowledged be •� gni e�- 4 o was cknowledged before w 20 �y 50& this day of 201 b o Ms { COUNTER REVIEW REVIEW REVIEW d ins REVIEW REVIEW DATE rr ledging ) 3 a;: 1 (Name of person acknowledging ) 11 F oA (Signature of Notar V ublic- State of Florida ) Personally Known ✓_�OR Produced Identification Type of Identification Produced Commission No. Revised 07/15/2014 (Seal) (iL/ (Signature of Not Public- State of Florida ) Personally Known / OR Produced Identification Type of Identification Produced Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS