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HomeMy WebLinkAboutBuilding Permit Application All APPLICABL INF `MUST BE COMPLETt FOR-APPLICATION TO BE ACCEPTED � Date: �� ► Permit Number: Y,.V'."X�%X.�, ,y��'iy^'ti�8.€`�,i't'`rv'F� {S�^`*�.d..d"�.f's••�:5 2016 �. .�. M Building Permit Applicationror�. ks FL 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: PROP® °EaD INPRO /EME" T L ATION: Address: c-sn�-"" 'C r"\1 — Legal Description: Property Tax ID#: ©i I Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: i Right Side: Left Side: Q DEA,P E!D R ETIQ ' f ORK: CO1 5� R CTI`0 NEO A* I p: Additionalwork to be perrormed under this permit—check all that apply: _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:$ t l l ®$-4 a 415 Utilities: —Sewer —Septic Building Height: ® SS. ONhRACTO.. Name Name: Address: }l'S ►?x>4C� Z�(-\.\/e. Company: City:Ta State: -- 'Address: Zip Code: 2_ Fax: City: State: Phone No. 42/ �i�,— `l-g�aJ Zip Code: Fax: E-Mail: �p�arn251�2c���cr�.�\•tam Phone No Fill in fee simple Title Holder on next page (if different. E-Mail from the Owner listed above) State or C my License If value of construction is 2500 or more,a RECORDED Notice of Comm cement is required. i SUP a T t'NSTRi CTtON FIRM LAW IiNFQ . 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 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 Commercement 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. R., Signature of Owner/Less ee/Contrq for as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA 4 STATE OF FLORIDA COUNTY OF i)CJ 1� COItNTY OF L - The forgoing instrument was cknowledged before me The forgoing instrument was acknowledged before me this_(i-day of nQnW 20-4 by this day of ,20_ by (Name of person acknowledging) (Name of person acknowledging) _(STgnature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced VP KAREN S. N ELSEN COmmIS510n NO. °� Commission# F (t6KI n No.. (Seal) =N _ dg My Commissio Expires - June 12, 018 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER 'REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED J Rev.