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HomeMy WebLinkAboutPermit Renewals All APPLICABLE INFO M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: 4 � Building Permit Application AUG 2 9 2016 Planning and Development Services PERMITTING Building and Code Regulation Division 5t.Lucie County, FL 2300 Virginia Avenue,Fort pierce FL 34982 'Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: PRPQSED (N 'RC7VEM0 IRS N4 TON: Address: Legal Description: Property Tax ID#: a W - Lot No. Site Plan Name: Block No. Project Name: - ---�-� Setbacks Front Back: Right Side: Left Side: •-- DETA(LED DE�SC* +IP i0 0' WOR+ co CONS TRUC �' ' NFOR :ATIO : Additional worK to be performed under this permit–check all t at appy: —Mechanical _Gas Tank _ Gas Piping __Shutters Windows/Doors _Electric _Plumbing _Sprinklers _Generator Roof Total Sq. Ft of Construction: Sq. Ft.of First Floor: G t-- G e J_ Cost of Construction:$�_ f Utilities: _Sewer _Septic Building Height: OWNER LE�S�SF CONTRA TOR. Name Name: Address: ^ r Y. Company: ' ;m' ;•:• ix ,�.« State r City. :Addre'ss:' :,,.- Zip Code: Fax: City: State- — Phone No. '2� --�{�-�,� 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. SUPPLEMENTAL CONSTRUCTI©N LIEN LAW INFORMATIOi�I: 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 bund 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 commencin -work or recording our Notice of Commencement. ig"n urffLORIDA er-Les Co actor as Agent for Owner Signature of Contractor/License Holder ATE 1 STATE OF FLORIDA COON �? . l_ 1 (F. COUNTY OF The or ping instr ent was cknowledged before me The forgoing Instrument was acknowledged before me this day of 20] by this day of .20_ by IRA (Name of perso ackno ledging) (Name of person acknowledging) (Sign ture of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identifiotio'rl Type of identification Produced � �� d KAREN S. NIEL EN Commission q FF 1 37 SIOn NO. Seal Commission No. l)My Commission E)p�r��' ) June 12. 2018 REVIEWS FRONT ZONING ' SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE LETED Rev.7/2014