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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: 2- O 0 ECIE--9V Building Permit Application Planning and Development Services DEC / 4 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: To Select from dropbox, click arrow at the end of line PROPOSED'IMPtROVEMENT LOCATION: / Address: `f 6ys- Jia e©Pr YIQq?i'(.F0 '-t lPi-e►rt-•e , Legal Description:�01'C'ay S/D-2li.se I 1-8- LA f z{l l a 0 /311 /Il ��R -33 z 3 —2-k-.3 9 Property Tax ID#: 1-51-Z- -80 r -OZ 19(- UDpr 3 Lot No. / 1 Site Plan Name: /g Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DAETAI,,1LED�DESCRIPTION OF WORK: . � s f� fio./r eF ux;^ cam-n�e s1 -tf:e 011'e-0 ) -word "on aCO;N'STRUCTION-INFORMATION: Additional work toe e Orme under this permit-c ec a pp y: HVAC E]Gas Tank E]Gas Piping _Shutters Q Windows/Doors 11 Electric 1:1 Plumbing Sprinklers E]Generator E] Roof Roof pitch Total Sq.Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ Utilities: Sewer Septic Building Height: OWNER/LESSEE: CONTRACTOR: nqr yrk[. - Name DI` Name: Address: 0s iv e_ Company: City-��r-f` �Pc e State: Address:.-3/0e Zip Code: -3 �Zq S/ Fax: City:FP- Lrt P� �e.��� State: Phone No.72Z - 2�EU Zip Code: -3Y 1f'S, FaxV. Z •7Q7• E-Mail: e Ct Q , ri Phone No. 2 l S Fill in fee simple Title older on next page(if different E-Mailde4 from the Owner listed above) State or County License: If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SU`PP#LpMEN'"T' 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 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. _V__) . - \ r_- ��: Signatur of Owner/Lessee/Contractor as Agent forSignature o Contractor/License Holder STATE OF FLORIDA ++ °'` <=1' STATE OF FLORID `a_ COUNTY OF f " COUNTY OF • , W Thelo going ins ent was acknowledged efore q „ The forgoing Inst ment was acknowledged before Q '`a trn a YC7 D �Ct ;y this day of✓J C C ,20 1 by 1 2? �; this�day of z �4 o rn m; m= ;w is2i4r� �a,Sse( MlC i¢l- U4-) Sse �Pp -- �_. . -.. Name of person making statement �,� Name of person making statement mT Personally Known�OR Produced Identificat' rt- T? Personally Known ✓ OR Produced Identificati �'a m Type of Identification _ Type of Identification . Produced `°N Produced N 01'r 11h (Signature of N t ry Public-State of Florida (Signature of N a Public-State ofFlorida Commission No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.8/2/17