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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION'v All APPLICABLE INFO MUST BE COMPIl- if"A FOR APPLICATION TO BE ACCEPTED Date: ' 2`7 SCANNED Permit Number: 0 ;2-0I BY :.. .. «' , 5 � r St. Lucie CountV. ' - a — -- - Building Permit Application FEB / 9 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 .l Residential PERMIT APPLICATION FOR: PROP©SED INPROUEMENT LOCATION: Address: 76 HA ✓/.STA $L 6/t> Legal Description: 7T.ucrZ ?.9[2W-0,-rrT 3-13&N ZS L6-r- II 74A? 3y/2zsoi/701-17 Property Tax ID#: 3 4//,9S/ V6, S'0 O OO Z Lot No. Site Plan Name: Yoq.yllu r2ST ?A1ZC t; (- Block No. Project Name: Setbacks Front Back: Right Side: Left Side:.2 6 DE �A)LED DESCR PT OKl 9V WORK: -RPMovle EYrST[46 0.00Cft. GiC , z►- M 3'e+CCG .PC. �R2rs/ r� Gar / A/0-- 3 per, Se.4ceS'[ PA.4-,,jA6e- 45 lPE,'2'• S/rE- ?L4,r ncrtya2eT'8 6"`7-f- rG K 5-�- CO 5 RUC ION NFORMATION: Additional wor to De pertormea un er th is permit -check a ['that apply: Mechanical' _ Gas Tank _ Gas Piping j ; : .. ' Shutters _ Windows/Doors77 Electric Plumbing _ Sprinklers! ' , ' ; Generator _ Roof Pitch _ _ Total Sq. Ft of Construction: Sg. Ft: of First Floor: Cost of Construction: $ 4 2 (o f7 • L9 0 Utilities: , =' Sewer _Septic Building Height: OW E /LEDSSE : CONTRACTOR: Name: f'�/C!'/f►2D tUf(.LE' Name�f�lC14�A�:%�=`A'C��]iuiZS6 Company:F4-VECLe 7-2ARp2 $ r,12ct c Addt@ss:z/ E:•.RAr2•Chaega±( L-A Ms T a• C y�+Gth'" i State: 7 CA/rIPSELc c Address:% / IZ City: FOr2TiJiGr2[E State: Zip Code:3ycf!V7 Fak:•772-,97 V3RH Phone No. 7 7-1- - 2 / Y- 8 6 V 7 re Zip Code: 3 Y9 yS Fax: Phone No 5 1 E-Mail: &Ai2 ti00,S (6 COMC&; F- r4 C;T- Fill in fee simple Title Holder on next page (if different E-Mail T /3Z—V l ci76 SM A r C, C6 ," from the Owner listed above) State or County License If value of construction is 2S00 or more, a RECORDED Notice of Commencement is required. SUPPLEMf-NTAL CONSTR ONEIEN LAW INFORMATION: DESIGN .E�R/ENGINEER: Nam -.AD JKS_NNE.D _ Not A plicable E' C, P6Si6,+ MORTGAGE COMPANY: _ Not Applicable Name: Address:t OASO SL�•yr GA6E 7K� Svir&�ol Address: City: t�L�RT ST Lv C- r E Zip: 3ilfYV Phone VT State: V F c SLD 1 - 0177 City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: Name: _ Not Applicable BONDING COMPANY: _Not Applicable 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 Countyy 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 andaccessory uses to -another .nonresidential use WARNING TO OWNER: Your failure to Record a Notice of Commencement.rriey 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 vour Notice of Commencement. • Xa6 lMc s gni aFW7FP-0 n`e Les /Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA : STATE OF FLORI -'COUNTY•OF � R:. COUNTY OF �r :° • , The forgoing inst ent was acknowledged before me gv,,,, he forgoing instrument was acknowledged before me this I l day of 20_' by his 7t�day of , 20L by (Name of person acknowledging) (Name of person acknowledging(Signature of tary Public- State of F orida) L (Signature of Notary Public- State of FloridaPersonally own OR Produced IdentificatioPersonally Known OR Produced Identification Type of Identi 'ca 'on L Type of Identification D Produced . Produced L Commission o. _ (Seal ) c Commission No. 6- / ;�• n Nafatfy,P��lic - Snie o1 Flarida Cmm , _. ,� ..- slon,0FF921971 'I'<,a,�.o� .My Comm. EMpires Sop 27.2011 onn. REVIEWS FRONT ZONING ", SUPERVISOR PLANS VEGETATION SEATURTLE -MANGROVE COUNTER REVIEW''' REVIEW REVIEW REVIEW' +REVIEW '-: REVIEW DATE RECEIVED DATE COMPLETED 11 Rev.7/2L14