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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: � , ' O' Permit.Number: / 7 #'•mom' - _ Building Permit Application Planning and Development Services MAR 1 5: 2018 Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 �( Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential �b PERMIT APPLICATION FOR: PR©POSED INp.ROVEMENT L©CATIQN: Address: Legal Description: Property Tax ID#: Q -' & 0 a r (ono Lot No. ( rl Site Plan Name: Block No.-I Project Name: Setbacks Front-z6 ,, Back: c)Lk Right Side: Left Side: DETAI111ED DE3SCRIPTION O.F WOR{IC: STed V. JT Ire- n e n=. CONSTRUCTI'S NI IN61 FORM5 NATII©.N: Additional work to be performed under this permit-check all that appy: _Mechanical _Gas Tank _Gas Piping Shutters Windows/D66rs Electric _Plumbing _Sprinklers _';Generator _Roof Pitch Total Sq. Ft of Construction: 00 Sq. Ft. of,.Eirst:.Floor:- Cost of.Construction:$ /! 00. 00 Utilities: —Sewer —Septic Building Height: OWNER/LE--SSEE: CONTRACTOR: Name C-R- Name: Address: 57210 Pa fdy�� a �r Company: City: -VA , �I -�G�'. State:�(. Address: Zip Code: �3 tkq5I Fax: City: State: Phone No. 7 2 - 76 -- 6 ci Zip Code: Fax: E-Mail: tnCC -M i ke- ori �' L OUk- Phone No Fill in fee simple Title Holder on ne 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. SUPPi.E1UlENTA+L CONSTRt1CTfON LIEN LAW IN wORMATI ;N DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLEHOLDER... 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. Signatur of Owner/Lessee/Contractor as Agent r( Signature of Contractor/License Holder STATE OF FLORIDSTATE OF FLORIDA COUNTY OF . _ a COUNTY OF 13d co The for ing instr'ment was acknowledged bef a The forgoing instrument was acknowledged before me this 4fa day of 20D oX€ this day of , 20_ by co ch i,n&e . =ate* ) (Name of person acknowledging ,: (Name of person acknowledging) (Signature of Nota o Public-State o Florida) (Signature of Notary Public-State of Florida ) Personally Known v OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced 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.