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HomeMy WebLinkAboutBuilding Permit Application > Ic, 11, All APPLIC&ABLE I iFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: . 7121?. Permit Number: l 219 JUL2 9'2017 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 COt1 mercial Residential VVV PERMIT APPLICATION FOR: Address: �� elle e, G 3 �� Legal Description: Property Tax ID#: 4/d ©L?D 4 Lot No. Site Plan Name: Block No. Project Name: DO&Ae OL k✓! Setbacks Front Back: Right Side: Left Side: i W�W I Cv e.4J 5 Additional work to be performed under this permit-check a that appy: _Mechanical _Gas Tank _Gas Piping —Shutters ._ . Windows/Doors Electric _Plumbing' _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft.of.First.Floor: Cost of Construction:$ (9 d- Utilities: _Sewer _Septic Building Height: Name Owl Name: Address: �"'�$ /'I�,(',e /' Company: City: F� �.�G�t,L State: Address: Address: Zip Code: 3 YtiTZ- Fax: City: State: Phone No. "?a - �i d�1`� Zip Code: Fax: E-Mail: Phone No Fill in fee simple Title Holder on.next page(if different E-Mail from the Owner listed above) State or County License if value of construction is 2500 or more,a RECORDED Notice of Commencement is required. 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 petmit,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 by recoeded and,,posted on the jobsite before the first inspection. If you intend to obtain financing,consult with lender or an attorney before commencingwork or recordingour Notice of Commencement. . re of Owner/Lessee/Contractor as"Agent.forOwner Signature of Contra ctoOdcense`Holder STATE OF FLORIDA N STATE OF FLORIDA: COUNTY OF / ' _ COUNTY OF The forming instru n was acknowledged�efore e~:z�,2. : The forgoing instrument was acknowledged.before me this LFday of 20 by - this day of ,20_ by OE gw (Name of person acknowledging) (Name of person acknowledging) I� (Signature of ry Public-State of Florida (Signature of NotaryPublic-:State of Florida) Personally Known / OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced .,._. Commission No. (Seal) Commission No. `` ` ": (Seal)`: ; 4 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION ',SEA TURTLE., :MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW ' REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.