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HomeMy WebLinkAboutBuilding Permit Application AII'APPLICABLEf INFO MUST BE COMP1E7ED FOR APPLICATION TO BE ACCEPTED Date: / - f' �7 Permit Number: f."YED - JAN 2 6 1017 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: P' � '®SED INPR01/EM /ANT LOCATIO . Address: J61. 3 /pG 66Ze „ ea,!,h An, &,1,54 Z uc,%e Legal Description: Say4,aaQ 4 /_/_" P�a-f PAct f2 Tflree 03LA- 1_o7 ,5_1 Property Tax ID#: Lot No. Site Plan Name: f / Block No. Project Name: J1 Pol.il kro6ke Sit�ol Setbacks Front - Back: Right Side: Left Side: D DE�SC�RI T Q � • -z O-D-D W IL CONS U � IN1=©RM T)ON. itiona wor to ape Orme un er t is permit—cec a A at appy: _Mechanical' _Gas Tank _Gas Piping Shutters _Windows/Doors _Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$moo(, no.(1f 0 Utilities: _Sewer _Septic Building Height: OWN R/ CO K,T WITS 0R Name T&-cl/1 Ac P o[ k ee Name: &T n e-li V Address:,3( 11 3 P2ti I� - Oelach Z-11 Company:{01 nnae- Z4.- City: porf-6�, L. ire' State:F_ Address:37(oSS w vL�s�� Sf _ Zip Code:3 qqs-2_ Fax: City:A t-+,54_L v r,,c State: 1- Phone No. R14-7- 23-3 - q q W Zip Code: 3 qq 3 Fax-722-31f3-9W E-Mail: Phone No77;L--3y:;-5!91n Fill in fee simple Title Holder on next page(if different E-Mail��L ,ham�°�,a +ti,/11-f from the Owner listed above) State or County License [1-5 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. i I 7 P'P CONS DNluffm Uwy RMWOOK110. DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable Name:R1 cA cxr ��vn irr�� Name: Address: R0, /,3r,y,,!5 Gl fo Address: City: F-4. P ear-� State: FL• City: State: Zip: , Phone 7 72-�1�'-S(;1�3 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 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 recordin our Notice of Commencement. Q), ,,/ N ��,k A (�-P Signa u e o 0 ner/Lessee/C ractor as Agent r3i�ex Signa u e of C n ractor/Lice a Holder ^� a�� �. ' wa C STAT OF FLORI =oma STATE OF FLORIDA �L&�4 COUNTY OF m� A COUNTY OF The forgoing instr ent was acknowledged efor r` ° The forgoing Inst u ent was acknowledged be 2 thisday of 20by ALL'm this day of 202 b s�X y �W a co �4 •.Y Na a of erson ackn led in "'�t��g'' N e ( p g' g) ( person acknowledgin ) �. (Signatureo otary Public-State of Flor a) (Signature of No Public -State of,Florida Personally Known OR Produced Identification/ Personally Known OR Produced Identification--- Type dentificationType of Idents ica n Type of Ide`ntff'c ion Produced w G Produced G Commission.No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REV EW REVIEW REVIEW, - REVIEW REVIEW DATE ii RECEIVED ( �? DATE COMPLETED-, ev.