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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPL CgA�BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: RECEIV'_ OCT 122017 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 PROPOSED IMPROVEMENT LOCATION: Address: I Lega Description: ZU ' l l — � QZ . r- C_-Z I ce ( Property Tax ID #: cJ V '� L Q �/ ® Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: - CONSTRUCTION INFORMATION: Additional work to be performed under tispermit—check all apply: 11HVAC Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors Electric 0 Plumbing U Sprinklers 11 Generator Roof ® Roof pitch Total Sq. Ft of Construction: S . Ft. of First Floor: 20 Cost of Construction: $ D © Utilities:0Sewer _ Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name r Name: 0S U I �� t Address: Db Q Y � Company: �u'Diaftp roof-i Inc City: State: Address: i�=i j.Q� (AL� Y1��V�i G 10 Zip Code: Fax: City: .�t� �i/'� -� State: Phone No. Zip Code:c�li-q 2 Fax: E-Mail: Phone No. Fill in fee simple Title Holder on next page (if different E-Mail: from the Owner listed above) State or County License: (.�( I?7-7,39% 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: 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 H e Owners Associ Lion rules, bylaws or and covenants that may restrict or prohibit such structure. Please consult with your Ho a wners Associate n and review your deed for any re rictions which may apply. Inconsideration of th granting oft sI nested permi do hereby agree that I will, in all respects, perform the work in accordance with t e approved anse Florida Bu' in Codes and St. Lucie County Amen ments. The following buil ing permit a licati are exe t from undergoing a full concurrency r iew: room a diti s, accessory structu es, swimmi pool , fences, w s, signs, screen rooms and accessory us tc an on-r idential e WARNING T OWNER• our f Ilure to cord a Notice of Commencement m result i ou ying ce for improvements to you prope y. A N ice of Commencement must be rec rded a post d on t e jobsite before the fi st insp tion. If ou in nd to obtain financing, consult with ender r an a orney efore commencin work r recor n o Notice of Commencement. /Z V Signature of Ow er/ Lessee/ for as Agent for Owner Signature of Contractor/License of r STATE OF RIDA t`7 STATE OF FLORIDA COUNTY O COUNTY OF The forgoing instr� was cknowledgd before me this May of 20 � by The f r oing inst{ t s a kn ledg d efore me this day of �l 2�0 by �551� �lJl.�l! 1 �� �� � �I� A imp, U+�r `-� Name of perso aking statement f Name of persorymaking statement Personally Known OR Produced Identification Personally Known / OR Produced Identification Type of Identification Type of Identification Produced Produced (Signa urE of Nutd, y Public-StdtUorida Signature o Ngt-ary-PublicState 8f„o,; Commissi IZOZ'EL aunt S32fIdX3 �ir, �.� C �W ^= MARLINA GODINEZ �* •, Commission Nab : - MY COMMISSION # GG(I�6 �: Z3NIO09 VNI-lUVW I •''+: ydQ' EXPIRES June 13, 2021 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17