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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE/INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: (-'ate' Y Permit Number: s Building Permit Application Planning and Development Services JAN 2 2 2018 Building and Code Regulation Division 2300 Virginia Avenae,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*II� ��ZOVEMENT LOCATION h Y Add ress:-qwo- S . �c� 11[2# 7 s Legal Description:7r-,jl' SJR erll 'O A/14- 1P11 QVfj6'- ;�I Property Tax ID ago " U� �� _ Lot din, Site Plan Name: '"` Block No. Project dame: 4' Setbacks Front' Back: Right Side: Left Side: x s n Wa DETAILED DECc�iPTIONr0F'1tVORK� . _ 77 d x lcec-.oi c 4w }s , CCJIVSTRUCTI INFORMATION x:.... . ,.k ..,, i . � ,. �.. Additional wor orme under this permit-check a appy:�ai HVAC Gas Tank ❑Gas Piping _Shutters - -�Windows/Doors Electric l`_I Plumbing ❑Sprinklers �Generator �Roof Roof pitch Total Sq. Ft of Cgr.,:_tr!;ction: S . Ft.of First Floor: Cost c,"r7nnstrucc��n:7 g©�• Utilities.. ' er Septic Building Height: OUtiINER/LESS j °y3 CONTRACTOR x . Name Address: 6 IOS4 Company: U-0 _9- id 1l2 City: �./� "� �i. � Stater Address: 5�/# 5. � C� f Zip Code: Fax: City:[LZ0 fr'l�/ k State '/r/ Phone No. M q�Q I,rF�ax:5zll 1"�r 4 ��Q��-'���S O Zip Code: E-Mail: r ` !` i hone No. Fill in fee simple ildq Holder on ne page(if different E-Mail: n�, �, , from the Owner "tV.,. d above) a�eo 1 County License:r&L -(�6!a" , If value of constru=-0t)r1 is$2500 or more,a RECORDED Notice of Commencement is required. ;777' DESIGNER/ENG�IEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable Address: Address: City: State: City: State: Zip: ` Phone Zip: Phone: FEE SIMPLE TA"OLDER: _Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: Address: City: City: ` Zip: r hone: Zip: Phone: OWNER/CONTRIAOR 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 co,L7 ult,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.youu, r property. A Notice of Commencement must be recorded and posted on the jobsite before the first inspection.'-lUy'ou intend to obtain financing, consult with lender or an attorney before commencing wor,,k.,or'recorclingyour Notice of Commencement. Signat&pe of Owner/Lessee/ o tract as Agent for Owner Si ature of Contractor/ticense Holder STATE OF FLORIDA. c STATE OF FLORIDA/] COUNTY OF COUNTY OF The forgoing instr merit was acknowledged before me The forgoing instrument was acknowledged before me this day of 3 r�LJa 20�S�by this 5 day of JO✓Yl UQ 1"' 20 by Name of;_vers n making statement ;.- Name of persor}-making statement Personally Known". OR Produced Identification Personally Known ♦ OR Produced Identification Type of Identification Type of Identification Produced Produced Signature of Notary P. e`ti FJ�r c a E GRACE HAUS (Signature of No Public- t Ior AB RLY L BOUDREAU�3Yl1 'Wo ublic-State of Florida !L ": MY COMMISSIONS FF2 �c C4 Psion�GG 018430 ���'7 7; (�fi;AES June 25,2019 Commission No�� a; ommission No. , My Comm.Expires Aug 30,2020 140 7)S9"157 Fb ndQNotwySoMe¢— REVIEWS ,FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE .COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE- COMPLETED Rev.8/2/17