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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONY, All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED C/ _ Il' Date: / /d-1 Permit Number: 1W Ica � T � "� SCANNED RP C„� j E® AJ1411191► St. Lucie County uct, 15 2016 Building Permit Application PERMITTING Planning and Development Services St. Lucie Co - -Building and Code Regulation -Division--- — - - -- — - - - - u Fl-- - 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: PROPOSED INPROUEMENT LOC-ATION: Address: OOS- <;i lvP_/ Q¢ IL t— F) e±ce Ft 3LA?,a Legal Description: Property TaxID#: VI��oZ�DO� ��(���� Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: APITME @NgWFTM OF WORK: au V-ay e ar d t?O STRUC 10 INFORMATI©N: AdaitionalworKtOliepertormea under this permit- cnecK all tat 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: $3?5 , Utilities: _Sewer _Septic Building Height: OWMER/LE-SSEE: reR CTOR Name io Name: Address: C Company: City: -e/"c-e- State: Address: City: State:_ Zip Code: 3 JQ ?a Fax: Phone No. %7 a - ni 1 - Q I C' Zip Code: Fax: E-Mail 1.Ulit,31C,_ C la.be.lISLoo-rk-Ae 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. DESIGNER/ENGINEE Name: Address: City: Zip: Ph FEE SIMPLE TITLE HOLDER: Name: Address: Zip State: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Address: City: State: Zip: Phone: BONDING COMPANY: _Not Applicable Name: 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 commencine work or recordine vour Notice of Commencement. Signat r 0 n esSee/C n ractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF SI) VWL a COUNTY OF The forgoing instr ent was acknowledged before me The forgoing instrument was ac wledged before me thisI dayof �er_ /�\2016 by ��� p� A l l A tI L'fg, this_ day of 20_ by (N of person acknowledging) d���6= (Name of pers ) /tu—reofotary rigntiture of Notary PubliFLte of Florida) Public -State of Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification -Produced Produced .-.emu l�zO•'192-1u�OLO Commission No. (Se )� 1AHNA INGRAM Commission No. (Seal) Notary Public - State of Florida 2 My Comm. Expires Dec 20. 2018 I,. Commi sion # FF 177249 REVIEWS FRO NL'"" li?6N�NedmroglSUPLRgVJS0Rs. PLANS VEGETATION SEA TURTLE MANGROVE COUNTER EVIEW REVIEW REVIEW REVIEW REVIE DATE I RECEIVEDDATE iJVL COMPLETED Rev.7/2014