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HomeMy WebLinkAboutBuilding Permit Application T ALL APPLICABLE(INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: ,© ��'t _ RECEIVED Building Permit Application FEe 1.2 zors Planning and Development Services F* ri •ng rpepsr�y� Building and Code Regulation Division 4lple,iroUrit 'nt 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 Address: 1,1410© C4 rr/ 1-311 W ,S Legal Description: or-S 6/x, / )4 ( 0 rZ l-' - S5-0 .' 33-: ---SYS) Property TaxID#: Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DES�CRIPTCONkOF WORK �'h r ,!';t !( N dLD -' s,. CONSTRUCTION INFORMATION' 1` Additional work to e e orme un ert ispermit-c check a appy: HVAC E]Gas Tank Gas Piping _Shutters Windows/Doors ❑ a Electric 0 Plumbing Sprinklers 1 Generator Roof Roof pitch Total Sq. Ft of Construction: _3q 0 Sq. Ft. of First Floor: Cost of Construction:$ J3 i o 0o Utilities: Sewer OSeptic Building Height: - x,::-. Name C1 n l Name: .�~ wo Address: 00jolo / t Company: City: L. Statefl- Address: / Si s. /'�✓I G��C% Zip Code: 3 .S Fax: City: PSS State: r2 Phone No. Zip Code:, Fax: -�I E-Mail: Phone No. Fill in fee simple Title Holder on next page(if different E-Mail: -J-, l"iSC60C 1/')4CD Cc. from the Owner listed above) State or County License: crc o J z-33 If value of constructionis$2500 or more,a RECORDED Notice of Commencement is required. I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION {A t ' 'V" C 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 thepermit 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 r an attorney before commencing work or recording our Notice of Commenceme Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contra ctor/Lic se Holder STATE OF FLORJ DA I STATE OF FLORID COUNTY OF S17. Ut C11 f, COUNTY OF The forgoing instru ent was acknowledged before me The fo�-rgPo,�ing instru nt was acknowledged before me this lay of ,11 0 ci by this ► 'day of ) 0 IGi by -F&) Name of person making statement / Name of perso making sta ment Personally Known OR Produced Identification/ Personally Known OR Produced Identification Type of Ide tification Type of Identification Produced >�t�l�— �(a5�- (� Produced (Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) P �I i'blic�Tj Florida Commission No. Commission No. niter Datds-- o�pRY PUpG Notary Public State of Florida r Jennifer Davis C . �'v My Commission FF 966029 ` �� C My Commission FF 966029 Y�o< o Expires 02/29/2020 v� fres r - ef f�o x p .. REVIEWSSUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.8/2/17