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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETE`D`FOR APPLICATION TO BE ACCEPTED Date: Permit Number: fro 19, - d a13 RECEIVED DEC 15 1016 — — Building Permit Application 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: `"'-_ kql Car a PROPOSED INPR© EMENT LOCATION: Address:_ SOS Jt &er- (:.k 17/, �f- A-elLtot r—L 3 Lp S� Legal Description: Property Tax ID k: 3y da' G 1$ - Odd - G Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: D' AILED @Wwum OF WOR CONSTR l IWWUN4251104412N. Adclitional work to be pertormed 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: Sq. Ft. of First Floor: Cost of Construction: $ J UOV Utilities: Septic Building Height: _Sewer OWN /LESSE CONTRACTOR: " Name:: Name bw,cl f: ..... Address: /F? ,Oc:- SJwer ii7,_{L�r - - Company`' City: } i e,- e State: FL- Address: City: State:_ Zip Code: J Li q. S a Fax: Phone No. -n a - q % I - S 11 S Zip Code: Fax: E-Mail: f:UliW)G_ C(& P)t11Sn,)i-h:nd- Phone No Fill in fee simple Title Holder on next page ( if different E-Mail State or County License from the Owner listed above) . If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. Name: Address: City: State: Zip: Phone FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: Address: City: Zip: Phone: MORTGAGE COMPANY: _ Not Applicable Name: Address: City: State: Zip: Phone: BONDING COMPANY: _Not Applicable Address: City.' 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 Your Notice of Commencement. Signature of Owner/ Lessee/C-ephtractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF SDI' - 1-a e % �, COUNTY OF The forgoing instrurpent was acknowledged before me The forgoing instrument was/anowledged before me this AS day of jDa qz 20A(; by this _ day of 20_ by S-%ro.cs L\) \w' 9 (Name of person acknowledging) (Name of per nowledging ) c (Signature of Notaryblic- State of Florida) (Signature f Notary Public- State of Florida ) Personally Known OR Prf~ uc en i ice EGN N erso al Known OR Produced Identification Type of ldentifiication k =?��"" =: MycoMm1SSIoNNGG 2;Td 19e Identification Produced V Ilf+i. IXPIRES:DOcemberl6 2BImd ed '•.'•' Bonded ihm Notary Publkn Commission No. emlten ssion No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW RE VI W REVIEW REVIEW REVIEW REVIEW DATE qj /„ /C��S COMPLETED ev.