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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COr rcLTED"FOR APPLICATION TO BE ACCEPTED , Dated Permit Number: 110 1 - f� Er"VE® • JUL 2 7 2017 ® Building Permit Application PERMIT 1NG Plani ing and Development Services St. Lucie Coun , L euila�'and Code Regulation Division ������� 2300�n9 9 Virginia Avenue, Fort Pierce FL 34982�.��� Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial % 69'idential PERMIT APPLICATION FOR: Address: C Legal f ;Description: Wo Property Tax ID #: / 7c I Site Plan Name: i Project Name: SetbaI cks Front Back: Aaaitionai worK to oe perrormea unc Mechanical _ Gas Tank Electric _ Plumbing Total !Sq. Ft of Construction: I� Cost of Construction: $ V W&Wu Right Side Left Side: Lot No. Block No. permit — cnecK aii tnat apply: _ Gas Piping _ Shutters _ Windows/Doors _ Sprinklers _ Generator _ Roof Pitch Sq. Ft. of First Floor: Utilities: —Sewer —Septic Building Height: OUriNER/LESSEE:.. _ C(�NTRACTQR: Name Name: Address: 13 LOA yq Company: City: State: I Zip' Code: r7 ^ Fax:: Phone No. lq4: Y/%— Address: City: State: Zip Code: Fax: Phone No E-11I%Iail:buz& o Fil� from in fee simple Title Holder on next page ( if different the Owner listed above) -Mail State or County License If va ue of construction is 2500 or more, a RECORDED Notice of Commencement is required. PPLEM �NTAL CCiNSTR CTI�,�` � EN LA �FOR�M il©• ; DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: of Applicable Name: _ Name: Address: Address: City: State: City:' State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable A <_ BONDING COMPANY: Not Applicable _ Name: Name: Address: Address: City: City: Zip: Phone: 'I 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 uch 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 failur to Record a Notice of Commencement may result in your paying twice for improvements to your roperty. Notice of Commencement must be recorded and posted on the jobsite before t lrs ` ' e ion. If yo ntend to obtain financing, consult with lender or an attorney before comnlencing Worr ecorcling ur Notice of Commencement. Sig ture of Own L ssee nt or as Agent for Owner Signature of Contractor/License Holder STAT LORIDA � - STATE OF, FLORIDA NTY OF %_ UL " COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me thiQA day of 20T7by this day of 20_ by i (a a of person acknowledging) (Name of person acknowledging ) na re of Notary Public- tat of Florida) (Signature of Notary Public- State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced Commission NotPrR°�I;�, :. 'A (eal) HNtINiiF Commissioh No: ;,(Seal)' `�. a`aCaer otary pob lic - S at - REVIEWS- C,., o mini, F_ROUTedthrou (Plres Dec s' 20 2 p20N'NQq7249 a g PERVISOR PLANS %-VEGETATION SEA TURTLE: MANGROVE COUNTER' f�b'I�tISFaryAs REVIEW REVIEW REVIEW REVIEW REVIEW' DATE RECEIVED DATE COMPLETED v. e I