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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: RECEIVED i Building Permit Application FEB 21 2016 Planning and Development Services Permit� ng Department Building and Code Regulation Division S1t'Lucfe County 2300 Virginia Avenue, Fort Pierce FL 34982 �v// Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: PROPOSED INPROVEMENT LOCATI N: Address: oft aS3 — /�_•q n 'J1/ C 3 9 Le ga Description: �m�� C, "mss /�f1/DA,%64J'�177L QTS_J!� jpN! Property Tax ID #: -701 - Ooz 3 a — C) p ©-- Site Plan Name: Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: On e-.)( ,,& 14 i Sri - .?1Q Lot No. Block No. 4X'G CONSTRUCTION INFORMATION: Additional work to be performed under this permit - check all that appy: _Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors Electric _ Plumbing _ Sprinklers _ Generator 'Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: i Cost of Construction: $ l �o� S Utilities: _ Sewer _ Septic Building Height: l0 . OWNER/LESSEE: CONTRACTOR: Name tie. C Name: Ra.1Rl�1 Address: Al. �3 S� Company: 12 City: /- , 10, Q R- CQ State: �l F!, Zip Code: If IF V w Fax: Phone No. -7 7,2 ffQ9- 5 %? foo- 96,?f Address: 4/% g City: p S. L - State: e( Zip Code: 3�9 �� Fax: c- --- Phone No 7 72- E-Mail: /l d SO_": Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E -Mail State or County License CCC l 3 3 3 a b If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: Zip: Phone City: State: 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 mus a recorded and posted on the jobsite before the fi inspection. If you intend to obtain financing, co ult ith lender or an attorney before commenci ork or recording our Notice of Commenceme Signature oflwner/` 44 see/Contractor as Agent for Owner Sigriatofn Af Co&t'i'dctor/cense Holder STATE OF FLORIDA STATE /OF FLORIDA COUNTY OF ! -i* LUC,;t COUNTY OF S� -w�;- The forgoing instrument was acknowledged before me this 2_day of r,&i 20L by (Name of p rson acknowledging ) K4, Qw," a ure of Notary Public- Itate of Florida ) Personally Known Type of Identification Produced D. `— Commission No. OR Produced Identification' REVIEWS FRONT ­ COUNTER DATE RECEIVED DATE COMPLETED The forgoing instrument was acknowledged before me this 'Z�_ day of C—(h 204 by R c� s4/ DINAS� (--CaMn-,.d (Name of p&son acknowledging— ", W, & A aj�_ ) (SAature of Notary Publict State of Florida ) Personally Known _ Type of Identification INGRANI wrociuceci .L— ""q�Fl ;tate of orida „ublic MY Expires Dec 20, 201 ommission No. a, r Commission # FF' 177249 ?ASS 1 G SUPERVISOR PLANS VEGETATION REVIEW REVIEW REVIEW REVIEW OR Produced Identification LASHAHNA INGRAM Notargl�My . State of Florida My Co m. Expires Dec 20, 2018 F\� Comnlissir_ FF 177249 P _ u9 I Notary Assn. SEA TURTLE ANGRY' REVIEW REVIEW