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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLEINFO MUST BE COMPLETED "FOR APPLICATION TO BE ACCEPTED __ 9 % Date: /0 - /% • % Permit Number: 0 Building Permit Application OCT 11 2017 a, 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 Residenfiial %/ r% PERMIT APPLICATION FOR: , p�p� PRQ;Pt7SED ih/1a0'1/E-MFNT LOCAfi101 Address; Legal Description: UU t 1 AJLJW e GQ Property Tax ID #: Lot No. Site Plan Name: Block No. `Z Project Name: _ Setbacks Front Back: Right Side: Left Side: ::DETAILED pESCRi'PTION O WORK ,, b UC uj f? 6 -k U W ICI (z,ep � Q � e�or : k�� �'E�cPj p,e lice fie. ') � 1►��3�LL uotCJ� O t"_duvec-t WASKiN 11Uock t'='``j:. (.a�e-%o �Q�iC� C2eY e R%, �as� y"j1161 Zfi v ealy� way w J � cc.C. U� ��ol �Zc r' �'� i�e`� uLU �jp''�.• 77 ultional 'L L s% uo� N work to e pe orme"un er t is permit — c ec a t at apply: ✓HVAC - Gas Tank _ Gas Piping _ Shutters Windows/Doors V Electric (/Plumbing _ Sprinklers — Generator 1/ Roof `:��"T_Roof pitch Total Sq. Ft of Construction': Sq. Ft. of First Floor: Cost of Construction: $ f� i Utilities: —Sewer —Septic Building Height: OWNER/, LESSEE CONTRACTdR Name Name: Address: Company: ©� City: .;, C' C State: Address: Zip Cod Fax: City: esSv L"l State• Phone No. Zip Code: Fax: _ E-Mail: Phone No. '1 t(2— q 2 Fill in fee simple Title Holder on next page (if different E-Mail: kK-C_ O� �'�c '.' �e from the Owner listed above) State or C unty License: CGC IT, - If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. O SUf�RL�,�VIENttAL �Q�ISTI�#JCTION, �(�#�I LA111IutNF'ORIVR,ATIt�N 'fr , DESIGNER/ENGINEER: ,Not Applicable Name: MORTGAGE COMPANY: _Not Applicable 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 Commencement 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 Your Notice of Commencement. 4MA4 a Signat r of Owner Les eJCo_ntmctoasAge6t for Owner Signatu STATE OF FLORIDA —` STATE OF FLORIDA COUNTY OF b-� �V C� Q COUNTY OF The forgoing instrum nt was acknowledged before me this ko_gdayof ;CiP , 201':3r-by Name of Oerso aking statement Personally Known OR Produced Identification Type of Identification Produced �& Ai.,z- (Signature of No v� ���hll�- State of Florida Commission No. =' MA DE LA Ly?e.MpLASCO COMMISSION # GG050399 EXPIRES November 28, 2020 REVIEWS FRONT ZONING SUPERVISOR COUNTER REVIEW REVIEW DATE I COMPLETED Rev. 8/2/17 The fo QQIng instrument was acknowledged before me this /LVg iay of 04c)* e ✓ 20JJ by 6 :5 C12- 57irn-211 YX r Name of person mg statement Personally Known OR Produced Identification Type of Identification Produced I aCr�y ��-0" _A (Signature o f Commission1_6 MY COMMISSION PLANS I VEGETATION I SEA TURTLE E)IIEW REVIEW REVIEW MANGROVE REVIEW