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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: RECEIV77D APR 28 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 ',�. �M PROPOSED IMPROVEMENT LOCATION: Address: ( n205 SeNASTI Ab3 &A1) Legal Description: "C QqO S �E6i3f�Si f -All ) W - I%10Eis30(_,b (�AKy .(LI La ►- HaP 131145) (02aoagIa.1 I Property Tax ID#: 1 301 - (8 14-©_1935—CW 3 Lot No. 15 Site Plan Name: Block No. I Lp 1 Project Name: Setbacks Front. Back: ;k•"( Right Side: t� 4�Left Side: DETAILED DESCRIPTION OF WORK: CONSTRUCTION INFORMATION: Additional work to be performed under this permit—check all t=apply: 13HVAC Gas Tank ❑Gas Piping Shutters a Windows/Doors t-,�I 11 Electric 0 Plumbing Sprinklers _Generator Roof Roof pitch Total Sq.Ft of Construction: _5_71O S .Ft.of First Floor: Cost of Construction:$ ��,boo Utilities:11Sewer Septic Building Height: OWNERAESSEE: CONTRACTOR: Name N t wLe H AV'e6 Name: U Address: Mo-5 �1=-i i�S�"i flt�l Cb• Company: 'DkvE. M 1 L( 17A City: �=)ar PI UCfn, State:FL• Address: 5 is as ,31— Zip Code: "�2R Fax: City: f=70 _T R F ikc\=, State:, Phone No. Zip Code: 349 Q I Fax: Al el ,W'59 E-Mail: Phone No. T1a L 1 -"'060 Fill in fee simple Title Holder on next page(if different E-Mail: l� U►aLl I y I r' �l�S(31)I j-I- t�3 from the Owner listed above) State or County License:ULI 25-7 732 If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: - 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 the permitholder to build the subject structure, which is in conflict with any applicable Home Owners Association rules,bylaws or an 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 a d posted on the jobsite before the first ins ion.If you intend to obtain financing,consult with lend r an attorney before commencinia w r recording our Notice of Commencement. Zf Signatur of Own essee/Contractor as Agent for Owner Signature of Cbntractor/License Holder STATE OF FLORIDA STATE OF FLORID . COUNTY OF �'=� . Lc�.rr..l COUNTY OF �'�"�The for ng instrun nt was acknowledged efore me The forgoing instrument was acknowledged before me thisday of r 1 20�by this-La day of jM rVJ 20 L 7 by (Name of person acknowl dging) (Name of person acknowledging) S' t e of Notary Public-State of Florida) / (Si at re of Notary Public-State of Florida) Personally Known OR Produced dentific tion y Personally Known c/ OR Produced Identification Type of Identification.Produced sV Type of Identification Produced tl F - 09Ll 2 Commission No.�Ei ��Kip c9S1A Commission o: 10 G �u�t6a �yy p LAURA State ;o- �a�, public Z8448 ;r, , Notary Public-State of Florida •� a a Revised 07/15/201 � Comte Expt�es$6o a�Y ASS, =9;F o� Commission#FF 094692 MY Com ationat N0�• OF F�p` Bonded Through National Notary Assn. VAR REVIEWS FRONJ-W*50Nr SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE rlITIALS SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: 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 the permit holder to build the subject structure which is in conflict with any applicable Home Owners Association rules,bylaws or andcovenants 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 a d posted on the jobsite before the first ins ion. If you intend to obtain financing,consult with lend r an attorney before. commencingw r recordin our Notice of Commencement. s Signatur of Own essee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF 54 . L&'Cr a COUNTY OF IV The for ng instrun nt was acknowledged efore me The forgoing instrument was acknowledged before me this day of r 1 20�by this day of .20 by l v\, (Name of person acknowl dging) (Name of person acknowledging) S' t e of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced denti tion Personally Known OR Produced Identification Type of Identification Produced is Type of Identification Produced Commission No.r� 0 ��� ,O Ac95T Florida' Commission No. (Seal) -Stag 2g448 C0MM% �o. ices$0 9. Revised 07/15/201 _ AS MY�d Qu9h National Notary A55 REVIEWS FRON NING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIE)YJ REVIEW REVIEW REVIEW DATEoS- COMPLETE / INITIALS