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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLET1_ OR APPLICATION TO BE ACCEPTED Date: —� , Permit Number: : t ar g RECEIVED JAN 212017 _ , Building Permit Application Planning and Development Services 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: e PR*'P0- ED 1NPROVE ENT LOCA IQN: Address: "� 6 L`" t /� t`N a ✓e.e— _3Q I t3 Legal Description: Property Tax ID#: �a11— �14�—da13— c�y� —�i Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: D' ED � ES•R I Y e., 1Sf0LJ is C 1 p 1111 CTI 6NP©RMA tON: Additional work toe,pe orme un er t is permit—c ec a t at app y: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft.of First Floor: w Cost of Construction:$ Utilities: _Sewer _Septic Building Height: OWN �R 51 M F,IRS ITI CTOR: Name ,r '. Name1 ;. Address: .. _ .. r :' n IC ' n . City: _:.. State:4V, Address: .- ,1 S-C — 1 of 571 Zip Code?3q Ce3 Fax: City:525CL State. Phone No. '5(.e i Z`5 3 '3 D 9 Zip Code: Fax: E-Mail: - Phone-No -79,21 We 7 Fill in fee simple Title Holder on next page(if different E-Mail from the Owner listed above) State or County License C,GL 54p If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. �O 5 U=10WMI is A I• N. DESI ER/ENGINEER: _Not Applicable MORTGAGE COMPANY: -Not Applicable Name: Nam ,: Address: Address: City: State:, City: State: Zip: Phone Zip: Phone: N11 FEE SIMPLE TITLE HOLDS _Not Applicable BONDING COMPA 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 an ' stallation 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. Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF S L v c'N Q COUNTY OF Sk. `- y c The forgoing instrument was acknowledged before me Thefor oing instrument was acknowledged before me this 3.� day of���1 ,20\ 1 by this�� day of �a-C\ ,20_\3 by N , t�: �h�\q � (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary P lic-State of Florida) (Signature of Notary, ublic-State of Florida) Personally Known OR Produced Identification Personally Know OR Produced Identification Type of Identification F Type of Identifica o •..�.., .fit, DEANNAMARIEGN_NS Produced D �MaRIEGNENs Produced - MMISSION#0002023 �. _ #GG 022023 EXPIRES:December 10,2020 ' ;o�c IM,Dere 1 2020 Commission No. o F `'� Banded'(i ryPubk1.11enr:ter i Commission No. • ` Notary hers 4 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEYV REVIEW REVIEW. REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 112014