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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION_r ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ++ r� Date: Permit Number: 1 I l a- oa�7 FRECENED Building Permit Application DEC 1 1 2017 Planning and Development Services PERMITTING Building and Code Regulation Division St. Lucie County, FL 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 P,,ROPOSED,I'MPROVEIVIfNT LOCATION:. � . Address: '% D)ptve7lid l �, I Legal Description: 0 3b38 00 O o / - Q` 1 -6 Property Tax ID #: 3 -1/0 - f i 1- 0003=0- 20-(n Lot No._ Site Plan Name: (� Block No. Project Name: Setbacks Front Back: Right Side: Left Side: 0 1.1A ,DETAILED`DESCRIPTION OF WORK: .--up,stc,11 ro0 6I le ©rne . CONSTRUCTION INFORMATION: Additional work to be performedunder tis permit -check all that apply: �HVAC L.J Gas Tank Gas Piping _ Shutters a Windows/Doors La Electric ® Plumbing Sprinklers n Generator � Roof Roof pitch Total Sq. Ft of Construction: S Ft. of First Floor: S ?9 1 Cost of Construction: $ C5o© Utilities: Sewer N Septic Building Height: 76 'OWNER/LESSEE: CONTRACTOR: Name h Name: Ro C&et Address: S Q nv -r O lAQ Company: City: "T)r State: Address: J t Zip Code: �' Fax: City: State: Phone No. 7a 75 " Zip Code:97,57Fax: 3S� - ,o5b E-Mail: N ct ra 0 1c1 Phone No. 3.51 —915-3 Fill in fees ple Title Holder on next page ( if different E-Mail: D `ci 1 A OCQ 14, cQYYI from the Owner listed above) State or County License: 5 3 3 6 IT vawe or construction is $z5uu 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: A --State: City: State: Zip:, Phon, Zip: Phone: FEE SIMPLE TITLEHOLDER: _ 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 authoriie the permit -holder to build'the subject -structure Which is in conflict with add applicable Home Owners Association rules;. bylaws -or and covenants that may restrict or prohibit such m structure. Please consult with your Hoe Owners Association and, review your deed.forany 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. M Signature of STATE OF FLORIDA COUNTY OF - Ic _ L.�AGig__ as Agent for Owner The forgoing instrument was acknowledged before me this day of /lJr) f/e? 1� b�f , 20J� by Name of p son making statement Personally Known ✓ OR Produced Identification Type of Identification Ptuduced (Signature of Nota Public- State my CO9of FI i Commission No. > PATRICIAA., ISSION P FF069060 °� EXPIRES: Nova 2.07, 2017 � v.n. Signature of STATE OF FLORIDA COUNTY OF ffG/�' The f� Ing Instrument was acknowledged before me this ///t day of 20J.1 by Name of person making statement Personally Known ,_ OR Produced Identification Type of Identification Produced A ,�Izi ok a . (signature of Notaryubfic- tate of Flo r' a ;�° CP Commiceinn Nn. REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA T E MANGROVE ' COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17