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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: L12 - I 1 Permit Number: Zo 1- o4Lo RECEIVED Building Permit Application JAN .2 6 2017 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: q c Sin e PR®POSED N `RO @M,MEN LOC TION: Address: q t ,41 j, � pp �,0/� ` Legal Description: I t/LP'� P(4 �� (A In l Elk l 1:1 l/�,Oluin- ���RS ) Property Tax ID#: V` �r1 'Doij�t � Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: (,�Right Side: �n , LeftSide: ,[Z� pE ► I p a ORK. _6 ai:i � 3 V4 lu oe e c4a t re 1' CONSTRU ON IN �O MA ION Additional work to be pertormed under t is permit-check a _t at appy: _Mechanical _Gas Tank _Gas Piping 'Shutters Windows/Doors _Electric _Plumbing _Sprinklers Generator _Roof Pitch Total Sq. Ft of Construction: 1?06 D© Sq. Ft.of First Floor: Cost of Construction:$ �iC_w) .lo Utilities: —Sewer —Septic Building Height: 0 N LE�S�S CO.NTRABCOMMUR Name y— Name: —Address: S Company: City: ' R Y4-S4 I(AD 1P State:FL- Address: Zip Code: ?LtOn Fax: City: State: Phone No. 73�g!X—CQ-1 Zip Code: Fax: E-Mail: ,I tft rh Phone No Fill in fee simple Title Hol er on next 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. 1 � SUPP EM A C©NS R ION -111PINA010,011N ER TI©N: DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable Name: i It AName: Address: Address: City: State: City: State: Zip: PhoneZip: 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 or an attorney before commencin work or recording our Notice of Commencement. Sig at e o__wn r/Less /Contractor as Agent for Li" Signature of Contractor/License Holder STATE OF FLORISTATE OF FLORIDA COUNTY OF COUNTY OF The forgoing ins ent was acknowledge before �o o The forgoing instrument was acknowledged before me this 4 day r 20/7 by rnK this day of ,20_ by 0 z onn to.. )zN T � C�T2 Na e f person acknowledging) (Name of person acknowledging) N / (Signature_o otaryPublic- at of Fldeida) (Signature of Notary Public-State of Florida) Person Known OR Produced Identification Personally Known OR Produced Identification Type of Identi ca 'on Type of Identification Produced Produced Commissio o. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIiEW REVIEWr�, REVIEW REVIEW REVIEW DATE RECEIVED _/W17 AiLIII i�A 1 DATE I IL`17 COMPLETED I Te—v. 7/2014