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HomeMy WebLinkAboutBuilding Permit Application I - i �te: 2-APPLICABLE INFO MrU�ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 2 ' 1 / Permit Number:r ( ) Rol `:ekz' ry FEB 2 2 2017 Building Permit Application PERFOITTING Planning and Development Services St. Lucie County, FL 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: PR N PE EDN OUR 10108.011 N.'IN KCOATIII Address: - I C 11irC� Le al Description: �r- (41&JO of rA,0D c F 1 b i S Ir IlP E r 1A E Property Tax ID#: 1� — l 1\ a�a ) d 'S Lot No. Site Plan Name: Block No. rIQ or Project Name: R;0 rez ) Setbacks Front Back: Right Side: Left Side: - D T IL ► D'ExS�R P ® 0 WOR a PAfkW Sfr c &M 6A1 w 46-S r Q i- U IC' C©NST CT ® LN 0 AN 10 -N: Additional work to be pertorme 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 Constructio Sq. Ft.of First Floor: Cost of Construction: - /�'� ` � ,d� Utilities: Sewer Septic Building Hei ht: 0 R/L�5�SE C«ONTRA TOR: Name Name: LL// Address: 7� r Wd _WAY Company: / n &W&Wl City: State: Address: /� pig•' Zip Code: Fax: City: State: Phone No. r � —3 1 Zip Code: Fax: E-Mail: t Gh n.D Sri e.R l t 00;C0A Phone No � �&�&—3 Fill in fee simple Title Holder on next page (if different E-Mail -e r G A vo COWL from the Owner listed above) State o m L y icense 3 R If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. 9JUtAWA1Vqr&11CqMMff9ffM LUM LVILM INF®RMAT O N. 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 permitto'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 too n financing,'consult with lender or an attorney before commencin work or r our oti of ommencement. ig a ure o ner Lessee/Contract 'Agent for Owne Signature of Contractor/License Holder STATE OF FLORIDA4 STATE OF FLORIDA COUNTY OF .LU(�I F� COUNTY OF The forgoing ins tru nt was acknowledged before me The forgoing instrument was acknowledged before me thisnUdayof 20L�_ by this day of ,20_ by L (Name of person acknowledging) (Name of person acknowledging) AA (Signature of otary Public-State of Florida) (Signature of Notary Public-State of Florida) Personally Known,'. OR Produced Identification Personally Known OR Produced Identification Type of Ident' 'c ti "°, f Identification { S. NIEL :X63d ed Produced 4' .` `'• KAREN Commission # FF 1�� My Commission ExCommission No. al) tuna 2, 201 m Sion No;: (Seal) REVIEWS FRONT ZQNfI SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 112014 I