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HomeMy WebLinkAbout1709-0115 All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: f 0- S' 17 Permit Number: /71REC r z-V V Building Permit Application . Planning and Development Services OCT 5 2017 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: EON, ®SED INPf:MEN LOCATI4 Address: ��I 5W WbP Pizl� F6gr Pia-4F- PA `4151 Legal Description: Property Tax ID#: _ ( i00 In Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DE�SCRIPI"ION OF 1N�RK: ENTli AJ'lP OyeRHa P &pg-v, 5�Rvvz:_ ��NWe F >� Siotzi� C®NSTR?IJCTION ,INFORMATION: ,... z Additional work to bii pe orme un er t is permit-check a tat appy: _/Mechanical _Gas Tank _Gas Piping _Shutters -Windows/Doors V Electric _Plumbing _Sprinklers _Generator _Roof Total Sq.-Ft of Construction: Sq. Ft. of First Floor:. .: Cost of Construction: $ 7J�•� Utilities: —Sewer —Septic Building Height: 011VNER�LE�SSEE CONTRACTpR,: Name �n{��JA (}f��e Name: 1 �`f Address: n I I S}(,hrJNoU Company: cm-Ei �L1RiL l�- City: State: Address:_ 76D3 YrNin�D Zip Code: 3 rjS) Fax: -))2-H(U- 21 J Z City: r org- PState: Phone No. %l Lf- 2_12_112-1� Zip Code: J-1 1P1El� �L 5I Fax: E-Mail: l mjCn ,© klIsn'A6. VA Phone No UP 579 -Z6b9 Fill in fee simple Title Holder on next page (if different E-Mail 5k\604V M5@- YAH00.600 from the Owner listed above) State or County License EL- 13606925 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. Sl1'PPLEIVIENTPk.CONSTR.l1CTl©N LIEN LAW INFORMATION pp MORTGAGE COMPANY. DESIGNER/ENGINEER: _ Not Applicable � 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-Ar recording our Notice of Commencement. AU/9 ' Signature of Own a se Agent ro: °�, Signature of Cont a /Li nse Holder STATE OF FLO ?u9 `' STATE OF FLORIDA =` COUNTY OFW _ COUNTY OF X C D The for oing instrument was acknowledged before" 9 The forgoing instrument was acknowledged before s this 5 day of (qC 2017 by z m�m . this .qday of 19(;� 2017 by n� (Name of person cknowledging) `°N (Name of perso acknowledging) % C O V� A T co < N (Signature of No y Public-State of Florida) (Signature of Notary blit-State of Florida) Personally Kno OR Produced Identification Personally own OR Produced Identification Type of Identifi do Type of Id ntifi do /� Produced C Produced {� Commission No. (Seal) Commission N (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.