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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLrfED FOR APPL7CAAIR MBE ACCEPTED _— Date:- BY Permit Number: V 0' (A St. Lucie County R'� r-essg�+y7® Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR: Building Permit Application AUG'[ 12017 PER[. ,G St. Lucie t,ounty, FL Commercial Residential Address: 7oCL 5 a IPX rn G,:> �>'tYlev-t tom/ KJtf �ie✓ce SH�'(11 uc/ccc Legal Description: �� 19 i 7� i 6/L<- ` 2 5r9/f CGGi e 5-, Property Tax ID #: Site Plan Name: Project Name: Setbacks Front Back: Right Side: Left Side: Additional worK to be pertormed under tnis permit- cnecK all tnat apply: _Mechanical _Gas Tank _Gas Piping _Shutters _Electric _ Plumbing _ Sprinklers _ Generator Total Sq. Ft of Construction: Cost of Construction: $ 70on, 00 Sq. Ft. of First Floor: Utilities: _Sewer _Septic Lot No. Block No. -Windows/Doors Roof Pitch Building Height: OWNIER/LESSEE: C©NTRACTOR: Name /,/inn C"0n Name: Address:e FXo GSYYrw.yatnv� Company: City: CGCri CQ.J,G State:-LL Zip Code:3L3C� 7 Fax: —6'/ '5� 213 Phone No. Sd/- (/7S ei6S-b Address: City: State:_ Zip Code: Fax: I?hone No E-Mail:fOu Fill in fee simple Title Holder on next page (if differ$ri from the Owner listed above) E-Mail State or County License If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. C �r SUPPLEMENTAL CONSTRU'ION LIEN LAW INFORMATION: DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone 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 reviewyour 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 commencin or our Notice of Commencement. Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA I STATE OF FLORIDA COUNTY OF COUNTY OF The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me this ir day of SY 201 '-1- by this_ day of. 20_ by (Name of person acknowledging) (Name of person acknowledging) 8zaL�ft teD Wnaturle of Notary Public State o Iori a) (Signature of Notary Public -State of.Florida ) Personall nown OR Produced Identification Personally Known OR Produced Identification Type of Ide ' ' do Type of Identification Produced Produced Commission No. (Seal) IF amiss n No. (Seal) LASHAHN 3C Public le of Florida MyyComm. ExP� `� FF 177�49 1 REVIEWS FRONT ZONI G ,;<SUPE115aionaPLAr965� VEGETATION SEA TURTLE MANGROVE COUNTER RE�%��EOFFoF FJbnYklErAi��REVIEW J REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 7/2014