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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: %-Q'G 1 Permit Number:iumm © MIMI RECEl'.' ..D SEP 2 6 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 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line tN't c�f PROPOSED II,,,0ROVEIVIENT LOCATI.O',N Address: -,C5 S Legal Description: Property Tax ID#: 23 3— 1 L+1 — Cr—b2- Ci Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK CQNSTRUCTION,INFORMATION = - _,. Additional wor to le nertormed under this permit-check a appy: _HVAC Gas Tank ❑Gas Piping _Shutters a Windows/Doors Electric El Plumbing Sprinklers 1:1 Generator F] Roof Roof pitch Total Sq. Ft of Constr c n: S Ft.of First Floor: Cost of Construction:�C�d . Utilities:�Sewer Septic Building Height: :OWNER/LESSEE{ ;` ''CONT CTOR - Name Name: Address: A VAS Company: L City: State: Address: O Com, Zip Code a Fax: 11 City:- State: ` rL_ Phone No. M — -� )l0 Zip Code: Z Fax E-Mail: Phone No. Z- Fill in fee simple Title Holder on next page(if different E-Mail: q from the Owner listed above) State or County License:� X bLQ If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW IN{FORMATI®N = pk 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. Signatu of wner/Lessee/Contrac oras Agent for Owner Signal e\o to nse Holder STATE OF FL IPA . STATES FLORIDA COUNTY OF � �JC.%� COUNTY OF Sk , 1,A)r I'Z The forgoing instrument was acknowledged before me The forgoing instrument was acknowled ed before me this'" day of S- Jr 20k] by this4L�o day of� '1! 20q by Name of person making statement Name of person making sta ement Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced L tla L Produced S L 10 L (Signature of Notary Pu ic-State of Florida ) (Signature of Notary P lic- Commission No. h . DEANNAMARIEGIVENS �J$�� (Seal) Commission N t4Z�' =:1 1 0MtAjsS10N(6�Qf2023 +�, `= EX IRES:December 16,2020 DEANNAMARIEGIVENS1p wY , Bonded ThN Notary Public Underwriters ^� ''s�o'° BION#GG 022G23 .� EXPIRES:Decel nber 16,202 REVIEWS F C _..«oP= WNWO-t-ry .500 PLANS VEGETATION SEA TURTLE MANGROVE C I bl7 ' REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.8/2/17