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HomeMy WebLinkAboutBuilding Permit application ALL APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED ) �q Date: �• 1q' ) 0 Permit Number. / u �� �� 5-, g -71 Building Permit Application Planning and Development services MAR 1 9 201 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:FMPROUEMFNT LQCATI01 : :.;;:: ... .......: .. . . ....... .. ..... ... . Address: Legal Description: kA-9(4 Cai:, 421 1 �P-110/1 74id Property Tax ID#: ��© � 4� —l6`��() �� Lot No. Site Plan Name: Block No. Project Name: Setbacks Front_ Back: �� Right Side: Left Side: DETAILED DESCRIPTION OR. V110RK �� 16/-' Sla vn �� /�o U f<o n COaVSTRUCTIQN IN.F..ORMATION :.:,. Additional work toe Dertormed under t is permit-check all that appy: ®HVAC Gas Tank ❑Gas Piping ❑Shutters t]Windows/Doors Electric ❑ Plumbing Sprinklers OGenerator ®Roof Roof pitch Total Sq.Ft of Construction:�?(,1r� 5 . Ft.of First Floor: Cost of Construction_$_ 0 Utilities:nSewer DSeptic Building Height: OWNER.LESSE '::= :::::' C{3NTRACTOR E: Name nC&r/' E ✓l Name:Me-A R J:� L Q& >1. Address: !e Company: . Ca k 11'e-V City: 4P LJ / S7t/'e- . State: Address: l�,(n" ���Ct Ll'pl, 4,t�_i'1 t r Zip Code: /6 /0/ - Fax: City: Stater„ Phone No.!?Z 230 ✓ 0 R -Zip Code:_:3y 9 5 _1 Fax:_T]D Q SDL- 1 ),5 � E-Mail: Phone No. `I `1 ,- a c� l `q r-i L Fill in fee simple Title Holder on next page(if different E-Mail: O t ', i1 I C% I -, (A' moS1 � .i C_ o from the Owner listed above) State or County License: to If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. S:UFPLEMENTAL CQN�TUCTION LIEN LRICV 1NFORNIATION 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 1 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 wok or recording our Notice of Commencement. 16441AYC tAl gignature of Owner/Le ee/Contractor as Age 'for Owner Signature of Contractor icense H6—[der(-- STATE olde STATE OF FLORIDA STATE OF FLORID y...V h""' ,, COUNTY OF LV COUNTY OF The forgoing instrument was acknowledged efore �; The forgoing instru ent was acknowledged before this 4 day of )_ ?C 14 JJ m this�day of /n, f 114— .20Oby a I am<�n� L0MZZName of pe >rr making tatement z m� Name of per making state Personally Known OR Produced Identificat �p m Personally Known OR ProduceType of Identification z cType of IdentificationProduced �T= Produced& N (Signature of NyrPublic-State of Florida) (Signature of N ry Public-State of Florida) 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