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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLLTED FOR APPLICATION TO BE ACCEPTED Date: 102• li• 17 Permit Number: l7i.1) - 01;�q9 Buillkling Permit Application R E LI "_. DEC 1 ' 2017 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: ':Sh ex� Address: 14 1 Legal Description: E Property Tax ID #: /�) ���• ©� i % ^ 0 00; Lot No. Site Plan Name: Block No. Project Name: Setbacks Front ,_<U t Back: ,j _ Right Side: 7, Left Side: r Y'P � � h � � n �e � r�� �l�o �1 ��i�rs �� 1. � /1b AF�a P'� 7v be TE'm b� Additional work to be performed under this permit— check all that apply: Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Electric _ Plumbing _ Sprinklers _ Generator _ Roof _ Pitch Total Sq. Ft of Construction: Cost of.Construction: $ 0• 00 Sq. Ft. of First Floor: Utilities: Sewer —Septic Building Height: OU1lN��R/L.E=�S`�SEE: CC►"`�`iRA �R Name th Name: Addresses /ate City: I— pl eice State: _ Zip Code: ' • 5- Fax: Phone N ._ 772 214 —(;1�%9 Company: Address: City: State: Zip Code: Fax: Phone No E-Mail: Nk.-Or.17 Fill in f e simple Title Holder on next page ( if different from the Owner listed above) E-Mail State or County License If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. DESIGNER/ENG�i7INEER: Iflicable Notr"�, Name: linoAeii '-, Uet I .,Jtri MORTGAGE COMPANY: _ Not Applicable Name: Address: Address: City: State: City: State: Zip: Phone I I Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable Name: Name: Address: Address: City: City: I Zip: Phone: Zip: Phone: I 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 t j at isigranting 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 reclulested 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 tIo 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 commeq.Q= work or recording our, Notice of Commencement. I{ 7 1$ Signature of Owner/ Lessee/Contractor as Agent for Ow66F11 Signature of Contractor/License Holder STATE OF FLORI COUNTY OF The forgoing instrument was acknowli this day of me C - ;I i A ! I STATE OF FLORIDA COUNTY OF pi ,Q M. _< rn��; efor rn ; hww The forgoing ins ument was acknowledged before a;' by i �' Z this 1�day of P_ 20D,by `a PJ S �n '7'z�c Name of.person making statement. ELL— Personally Name of person making statement. . �N -` I Known ✓ OR Produced Identification Personally Known J OR Produced Identifica ; - Type of Identification Type of Identification Produced Produced a&A41W_'x,'4_ (Signature of Vary Public- State of FI rida) (Signature of Vtary Public- State of FIcYrida ) Commission No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED