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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICA LE IINNjFO /MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: dT/, G Permit Number: ❑fix E'���; Building Permit Application NOV 3 Q 2017 Planning and Development Services Building and Code Regulation Division PER'nrfll7ft 2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie :nty, FL Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line '_PROP:OS'E^D"IMPR;OAVEMENT q LOCATION: Address' Legal Description:y aJ �� O`r 1Z� f �+ DF ►V< 4 ELE� dP (byr Lot -1 -- � aP AI A Property Tax ID #: t403 [ZD ^ 06y3 d ( 0 Lot No. Site Plan Name: /�_,f�Q�� Block No. Project Name:—fJ��1�� Setbacks Front Back: Right Side: Left Side: DETAILED, ;D.ESCRIPTION' OF,.WORK:::. ` ,c --s- �,KST,6�704 -S if'A:b 2 'K PS CONSTRUCTION .INF•ORMATION::, onalworktobenerformed under this permit — check all apply: HVAC LJ Gas Tank Gas Piping _ Shutters a Windows/Doors Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch Total Sq. Ft of Construction: G� Cost of Construction: $ /, 0166 S Ft. of First Floor: _ Utilities:DSewer 0 Septic Building Height: OWNER/LESSE,E:.. ; . :CONTRACTOR:.:. - ' Name Name:��fL y lC! Address: ©gJr' v r�l LDS � -17 Company: 6141 V City: ��/�L� Zip Code: Fax: Phone No. c� 2 ! Z State: Z72_ Address: /J?0(a City: V696 Zip Code: 3 () Phone No. State: Fax: 7 71 Z '" 419 D — - - 0 E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mail: ' l m State or County License: QS_77Z if value of construction is $25o0 or more, a KtGUKUtU Nonce oT l,ommenLe1nenL 13 1 CqU I Cu. w rY.5 .SUPPLEMENTAL"CONSTRUCTION LIEN LAWINFORMATION:" . DESIGNER/ENGINEER: _ Not Applicable Name: MORTGAGE COMPANY: _ Not Applicable Name: Address: Address: City: State: Zip: Phone City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: BONDING COMPANY: Not Applicable 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 our Notice of Commencement. Signature of wner/ Lessee/Co r for as A en or Owner Signature of ' ntractor/Licens Holder STATE OF FLORIDA STATE OF FLORID COUNTY OF - fit 2\V') L COUNTY OF 2, The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this _ _ _ day of _ __- 20_ . by this ' . day of _ 20__ by Name of person making statement Personally Known / OR Produced Identification Type of Identification Produced (Signatur'aof NBtary Public- Name of person making statement Personally Known L/OR Produced Identification Type of Identification Produced (SignatuNof Wotary Public- State of Florida ) �c Pa� JOYCE MICHAUD rl' Commission NOF =- _ (S iKY�OMMISSION FF083006 mmission Pvr.,,, Seal YCEMICHAUD a EXPIRES: A ril 25.2018E + MY COMMISSION # FF 083D05 Bonded Thru Notary Public Underwrite " � gi EXPIRES: Ap6125, 2018 Bonded Thf l hiPublic REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.8/2/17