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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: j ` o�3 ` f cs Permit Number: � � ' 78 T ✓^fes� � '"»�� '��z� �;�'u yr x;,?;� - Building Permit Application JAN 2 5 2018 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: PRUPOSED IMPROVEMENT 10CA'TIQN D Address: ', o rlA3qqs�� Legal Description: Property Tax ID#: -3 00 / D CtIS ` 6 0 O Lot No. Site Plan Name: Block No. Project Name: <7 P�- Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION t7F WORK 2Q ©� 3 �: �oI Pv c o tise r rw s/Cw /-4. -/ �CO, ISTRUCTION INFORMATION v. >A- 4 iti'o;nalmor to a er orme p under this permit-checkf 14 tat appy: . chanical Gas Tank Gas Piping `�=.~ Shutters _Windows/Doors fec Sprinklers`Electric —Plumbing — -�_:Generator _Roof Pitch UM-Sq Ft of Construction: /y33 Sq Ft `of FiCSf Floor: ;Cost of Construction:$ !.000 - Utilities! Sewer"' —Septic Building Height: QVIfNER/LESS,IE ; . ' CONTRAGTC?R �F 3 3 Name ,ns�A � �rr�� f/Yl �6re Z_ Na" ' � A � ro�svt. o -. o h Address: yeIdc Ilia Company.:` to City: SSC State: _/ Address: YO D- Ff 'cmac-` Zip Code: 3 y�1� Fax: City: f:7_f to,e. rC e- State: Phone No. 7 - a a Y/ • O a -1- Zip Code: 3(19-1-1 Fax: E-Mail: Phone No `7 a - Cv 3 y Fill in fee simple Title Holder on next page(if different E-Mail��.'s r 5 a�� ao1 S-(N o-9 oo ,r o from the Owner listed above) State or County LicenseCetC If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLWEN TAL CQNSTRUCTION LIEN LAW INFQRII/IATION 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 or recording our Notice of Commencement. Signature of Ow Lessee ractor as Agent for Owner Signature of ontractor/Licen older STATE OF FLORIDA STATE OF FLORIDA COUNTY OF K�T e r COUNTY OF o` ��r A N a The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged befog o CQ N this a3 day of Ja+�uo.; 2018 by this3odayof 50.r1�t,«-1 20th by _J =� LL � to � o < moo o n s r0 � U. Ck Oi V o 1r\� S^� h z L c a (Name of person acknowledging) c (Name of person acknowledging) N d E 0 p y o A p V W O V a Z v 0 Int Z .� m L _ b W \\IIIA (Signature of Notary Public-State lorida) c ? e e s (Signature of Notary Public-State of Florida) ;�0 0 10 _a Personally Known OR Produced Identifi tioPP� Personally Known OR Produced Identificat Type of Identification "I\'."';�,, Type of Identification Produced L D L 35A S O 1S 6936'/ Produced VI ) ,Sas o s 6 o Commission No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.