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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 3`aO��1• Permit Number: A t�dy� RECEIVED PIAR 2'0,2017 : r 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 ComirnerCial Residential _- PERMIT APPLICATION. FOR: .Q PROPOSED IMPROVEMENT LOCATION: Address: 1<7003 ZpuoL: 1AN"q Legal Description: �°121.�.0� (' nD�'T2l/ E'S T C-5 Property Tax ID#: Lot No., Site Plan Name: iU 4- Blo_ ck No. Project Name: - i W U,MT_9 � 5. . �or,c- ?I e L) Setbacks Front �`� Back: 2 & Right Side:. Left Side- 920 DESCRIPTION (W WORK• CONSTRUCTION INFOR+MATION: Add itiona.1 work to be per orme, un er t is —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:$ a Utilities: —Sewer _Septic Building Height: OWNE,REN C©NTRACTO� Name i�1t_HA-�� %3E-A-0/ Name Address: 1 ge),t) 3o2(DLE Eorripany. y1 City: 2A-- pr ER c-c- state: R_ Address: Zip Code: Fax: ,--- City: State: Phone No. Zip Code: Fax: E-Mail: W a-e g r r® au6 a96 h) Phone No Fill in fee simple Title Holder 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. SUPPLEMENTAL CONSTRUCTION LIEN LAW IrNFOR�MATION: DESIGNER/ EE _Not Applicable MORTGAGE COMPANY: ' of Ap`pli.cable Name: Ago, a� /At C Name: Address: / �0 Address: City: S L_ State: lr L- City: State: Zip: .?q1-9_-P Phone -771 7 S_ 1 ASS' 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, 1 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 improvem r roperty. A Notice of Commencement must be recorded and posted on the jobsite befo a fir t inspectio . you intend obtain financing, consult with lender or an attorney before c me cin ork or recordi your Njatite of Commencement. I Signa u Ow a ractor as Agent for Owner Signature of-Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this ab day of Q'�A-rGh 201-1 by this day of .20_ by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) Personally Known Personally Known OR Produced Identification Type of Identification ,, �kyiy UNDACOLE Type of Identification Produced ; ;Y MY COMMISSION produced XPIRES:August 16,2018 ~ R1 4b•`', Bonded Thru Notary Public Underwriters Commission No. IW D 3c4 Commission,No. (Seal) �,y REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW kEVIEW REVIEW DATE RECEIVED /I DATE p, , COMPLETED ev.