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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED, Date: 0 2 ` 19 'L Permit Number: —. �- R.ECEI�,'.:D FEB 21' 2017 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: To Select from dropbox, click arrow at the end of line PR�®.PLED IIUI ROEl1/I: L®CATIaN: Address: '3 Legal Description: l 3 2-s © LS ��C7 Property Tax ID#: Lot No. 5 Site Plan Name: Block No. �D Project Name: Setbacks Front Back: Right Side: Left Side: DETACL0; Df-�SCRI11200 ®F WOR+K: Lo P C®NSTR�LECTIt3N I'NFORMAT(ON: Additional work toa performed under this permit—check a appy: HVAC Gas Tank . E]Gas Piping:- Shutters Q Windows/Doors F]Electric 0 Plumbing Sprinklers ElGenerator E] Roof Roof pitch Total Sq. Ft of Construction: S . Ft.of First Floor: Cost of Construction:$ Utilities: _Sewer Septic Building Height: CIWNER/LEsSSEE: CONTRACT©R: Name'l c .): ,i .N Name Address: Ra h iC. rye City: State: Address: Zip Code: 3 W 2_ Fax: City: ,1 S C_ Stater Phone No. (2 506 Zip Code: 3 U _ Fax: E-Mail: Phone No. 6 Fill in fee simple Title Holder on next page(if different E-Mail: from the Owner listed above) State or County License: a5'13� If value of construction is$2500 or more,a RECORDED Notice of'Commencement is required. PAW.! `l1;PRLB EN�'�L C®NSTR#JC1"It1.N LIEN LAUI/ INI tJRl1/I�►1"1,4N 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: 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 commencing work or recording our Notice of Commencement. ---- s Signature of Owner Les ee/Contractor as Agent for Owner Signature of o tractor/License er STATE OF FLORI A STATE OF FLOQA COUNTY OF . S�. LV�, COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of*15A)J_ 20 0—by this QA day of 20 NT by O e,4, V \ -cS �":S b 3-@• 1 . (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Publi tate of Florida ) (Signature of Notaryblic-State of Florida ) Personally Known 0 errr' Personally Known Type of Identification ( u �,f, lg MVIARIEGIV Type of Identifica ed GIVENS MY COMMIS ,r ,tc C MMISSION#GG 022023 Commission No. 5 EXPIR �R m r16,2020 PIRES:De�16,2020 .'r•••.•o�• onded N bttaarypublicUnderw tars Commission No. ThruNote u icUUnderMters Revised 07/15/2014 REVIEWS FRONT ZONING SUPE VISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW RE IEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE y l INITIALS