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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r��7 Date: /° �� Permit Number: 170 Building Permit Application JUL 2 4 2017 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 PROPOSED IMPROVEMENT LOCATION: Address: S 4t S A it Z l9 Legal Description:lS`TUE t_ Vpr+a.r, l ts)=T 'y ' C K Property Tax ID#: o C l Lot No. 12 -(3 Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION'OF-WORK: CONSTRUCTION.INFORMATION:, itio a -workto e e orme under this permit-check a _appy: HVAC Gas Tank as PipiShue rs Windows/Doors" � 11 Electric Plumbing Sprinklers 0 Generator 4I Roof Roof pitch Total Sq.Ft of Construction: 2 G( L ci SQ.Ft.of First Floor: Cost of Construction:$ l 2 5 Utilities Sewer Septic Building Height: OWNER/LESSEE: CONTRACTOR: - Name M (A D ,DX_0&$ L L Name: Address: 'S'L S' V k�e t" C—0-b A v�; AM `i fS Company:0_00L GtA-tS 0_60L1 AJG- 11 City: OF—, qo f--, State: Address: �a�i3 ? i�C.at (�0 Dpi . Zip Code: 101-b Z Fax: City: 30 q Nim E�� State: F(- Phone No. '77 2 - Zip Code: _;�N3P Fax: E-Mail:QAAAXro©Sr(-C.0L.r0 C, ,, Cbt'x Phone No. � 1�J "37 W? - Fill in fee simple Title Hofder on next page(if different E-Mail: (''U S&ZA ( Q (leo( GAG-(-S coo(mge from the Owner listed above) State or County License: ClArc) 2z".9- If 3SIf 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 thelobsite before the first inspection. If you intend to'obtain financing,consult with lender or an attorney before commencing rk or recordingWur Notice of Commencement. s Signature of Owner/lessee/Contractor as Agent for Owner Signature of �p ractor/ 'tens Holder STATE OF FLOW� L�t.� FLORIDA j COUNTY OF COUNTY OF-S TheVr'lay g instrum nt was acknowledged before me The forgoing instrument was acknowledged before me this of 20��by this�day of TCS-n u Q 1��i 20 j by e-4- V rel Or r ' S / (Name pe son acknowledging) (NAime of person ac owledging) (Sig ure of Notary PublW State o Florida) Signature of Notary Public-State of Florida) 4 07 6� Personally Known OR Produce Identification�� Personally Kno [ d ny AMISiBrLIbOFlorlda Type of identification Produced T pe ►cation Prod c9e ¢°'s_ oar u c- etamfssion-,�-Ffrt86089 r� � , plc My Com Expires Dec 29,2018. Commission No.v v ��� n No f °F�°`°� SoNgAugh National Notary Assn., gaouq, DARCI E.11 EY Notary Public-sta a of Florida Commission #GG 010707 Revised 07/15/2014 : My Comm.Expires Aug 25,2020 111-"OF Bonded through National Notary Assn. REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS