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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: -1 1�% RECEIVED JUL 10 2017Permit Number: VI G1� oNr `ttlOR u y �l 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: �����fi•`�� PROPOSED INPROUEMENT LOCATIQ Address: le %k>ON Legal Description: Property Tax ID#: Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: 1,Y Ez 102 111 R a DfaSCRIPTI®N OF 1N©R+K: �s4aLL JOd J4mlp S&ViC£y NA� 91\14. LighS �O6Z IV&3 -'�WN M9 CONSTRUCTION INFORMATI©N: Aaditional work to be peffo-r-mi-e--d under this permit-Check all that appy: 'Vechar*el _Gas Tank _Gas Piping _Shutters _Windows/Doors •7ectrc; ,: _Plumbing _Sprinklers Generator _Roof Total Sq:E,t of Construction: Sq. Ft:`of.,First�Fldor: Cost of.Construction: $ vUlebl Utilities: S4'1'e ;'. Septic Building Height: }f OWNER LESS, C©N+TRA T Name M'IC S T C. Name: Adds' D l� CoFnpany 1. AN 0'-AWl\16N e&P_C� .IL _CIVC_• City: :O S 1-.4C( State: L AdydressCf�}Ia 27ip Coc}e �� Fax: City: 1=` State: )Q Phone No. Zip Code:,-- F E-Mail: Phone No Dd_-1119I `??alb Fill in fee simple Title Holder on next page (if different E-Mail W2 ��4dL, �fvl from the Owner listed above) State or County License • C412 Evalue of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPI'LENIENI"Ai.CONSR{l1CT'I®N k.l �N LAU111�N��OR�MA1'ION: 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. 1,� A&�� z� Signature of Owner/Lessee/Agent Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF :�+ mac,'e— COUNTY OF _%. L-,c The forgoing instru ent was acknowledged before me The forgoing instrum nt was acknowledged before me �day of this ( u, 20(l by this Lg`�day of 20(1 by �-1 T-w�„� `� mos-�-� ��-t�� � . ,�s►�- (Name of person acknowledging) (Name of person acknowledging) �;�s • ,b'�, (Signa re of Notary Public-State of Florida '•,` � :,� (Signature of Notary Public-State of Florida ) a Personally Known - OR Produced Ide ifi Acf' Personally Known ✓ OR Produced Identif at < o ; Type of Identification N T s Type of Identification 3 3� YP x � o Produced 3 3 5 Produced g �. A H co Co o si n G TT � � Commission No. F �`j 6ob9 (Sea r„> Commission No. ori b�69 (Seal o Cr S two W d N T W A T O G Q G. T_ Y REVIEWS FRONT ZONING 'QPEE I-VIs PLANS VEGETATION SEATURTLE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 712014