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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: �, '� Permit Number: RECEIV71 SEP 211017 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: To Select from dropbox, click arrow at the end of line�daF PROPOSED IMPROVEMENT LOCATION' Address: `? 13 rcle, I-V Ef RezGe_. F1 3-NSI Legal Description: Lor _7� l'nj:!�a 13 IQ U ©� 3�1 b`d a�eo Property Tax ID#: `3 .' Y, a, a-W ' d,6 0-`( Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: e CONSTRUCTION INFORMATION: Additional work toe performed under this permit-check a appy: HVAC E]Gas Tank ❑Gas Piping _Shutters a Windows/Doors Electric 0 Plumbing Sprinklers F]Generator Fg/Roof / Roof pitch Total Sq. Ft of Construction: C) Sq. Ft.of First Floor: 1 r1co Cost of Construction:$ ti 1�. d( �. Utilities: Dewer[]Septic Building Height: OWNER/LESSEE: CONTRACTOR: cc e Namey dry �I `'re,�tell Name: b��r%_ w Address:__ �) /3 �e � Company: ciof-k�n e— ..n-N LGL. City: FT -E �j��c e, State:_a Address: 197S S So C l-e/ichle. 5-r Zip Code: 14C�5-1 Fax: City: y4 6,4- Luc -e, Stater Phone No, Zip Code: !SAg82 Fax: E-Mail: Phone No. 7?.':� -�21.0 Fill in fee simple Title Holder on next page(if different E-Mail: S i1�e @�c itbea from the Owner listed above) State or County License: C �- 1322,!/76 If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. U .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: 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 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 commencina work or recording our Notice of Commencement. 21 - (_�)__Qvx Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License H er STATE OF FLORID4���,� STATE OF FLORIDA COUNTY OF COUNTY OF Thefor oing instromegas acknowledge efore me The forgoing instrument was acknowledged before me this day of 20by thi��,� day of J f 20 til by Name of person making statementName of person mak' g statement Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Iion Type of Iden ification Produced. Produced V L 1) L (Signature of of ry Public-State of Florida) (Signature of Notara. , DEANNA MARIE GIVENS q �v►u BRpWDYM00 E r Commission No. ��2 I `c commission#001 OQWmission No. MY COM S� N' Gv0G2U23 EXPIREember 16,2020Ftplres May 9, 021 ponded Thru Notary Public Underwdters a ,oakrrdTMuiWO� brvbn REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.8/2/17 �s