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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �7 Q Date: �a't� °off? 1T Permit Number: Building Permit Application DEC 2 7 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: To Select from dropbox, click arrow at the end of line. �►. PROPOSED IMPROVEMENT LOCATION: Address: / t/�-'L�N L�s�16 e /Icy Gour2 Legal Description: Property Tax ID #: —T� 2 D i 0 ' © D Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: R— f2(j1,� L 1AJ e �7ROAA D -2 D i L% rl;0 L / w c- / CONSTRUCTION INFORMATION: Additional work to be erformed un er t is p it - check all that apply: CIHVAC Gas Tank as Piping _ Shutters a Windows/Doors Electric 0 Plumbing 'Sprinklers F]Generator EIRoof Roof pitch Total Sq. Ft of Construction: Cost of Construction: $ S Ft. of First Floor: Utilities: Sewer 11Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name di I /L/l Name: C ecc.Ye-e C^j. -Zw� Address: /��' Q��.��+s. �S,�d�/)t� �' '7 Company: etZEC /7yA-Ch(.DO Address: 1_?6,C0 City: zmr,yo State: T Zip Code: Fax: City: re3&S rl a Stater Phone No. 1„ - Zip Code: 3 rl 9S Fax: �f (�/ (d 67 E-Mail: Phone No. Fill in fee simple Title Holder on next page (if different E-Mail: oSer ug-e &Aj i9'leve cUA.- from the Owner listed above) State or County License:, 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: Zip: Phone: City: State: 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 rnmmPnrin�r wnrkhr recordinc vour Notice of Commencement. /-7 Signat of wner -on or as Agent for Owner Signatur of C ntra or L't.cen"se Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF Zyz 1.4&P �i .; &L COUNTY OF %ito2-1�ry Q ry�7 The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of Ct . 20/ -7 by thislo day of Cr , 20 by Name of person making statement Personally Known / OR Produced identification Name of person making statement Personally Known Produced Identification _ Type of Identification Type of Identification Produad J Producedn 4a, Z 70 Z 6 (Signature N)t Public- State of FI ) (Signs ure of NoloPublic- State of Florida ) Commission No. ."a9P ��-, (SegyERRY TOUMEY ommission No. Notary Public - State of Florida SHERRY TOOMEY • « o •E My Comm. Expires May 19, 201 %Ni 0 4pQ: y Public -State of Florida REVIEWS FRO NT4 r Bonded Thrc yh National Not s t1PER� . ' -PLANS 'v>lp' VEGET.Q?fION i ion SEAT' # F h ' COUNTER REVIEW REVIEW REVIEW REVIEW ghN REV ti sY DATE RECEIVED q DATE •`p'ra""' .`�� �a SHERRY T �': LIMEY COMPLETED ?r°• .` f Notary Public - Slat, of Florida . Rev.8/2/17 ••, ��.om. �npncs may la, ZUltf nit Commission # FF 124535 Bonded Throuyh National Notary Assn. ' ��