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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l q U U Date: C\ -zn Permit Number: 41 a 1—d 1 l 3 RECEI`.' -0 SEP 2 72017 SCANNED Building Permit Application Byn Planning and Development services Sf'. LUCiG COU Building and Code Regulation Division tv 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Fp1?flPOSE1N11OVEMEIT LO`CATir3N �' ��a�3 v� #`' k .v...-..e_.e :. ..�:. 'h:'Ti4 ':.4.:}Y2 . i:a� YR i�t<• .✓� v Address: l ra ryR. 3"N Legal Description: Jl - WiCIL io (sl,6 +0 f_9L4'f•-b CQna I g 4412aN1(©e Property Tax ID #: AA 6U1' OOIq •OOO J Lot No I (o Site Plan Name: Q2 ,1 ICD Block No. Project Name: .p J-E �Back-3, Setbacks Front N 8 Right Side: % _Left Side: '�:i}44 `3,t"s'+FA "'i=ikf3vr�.+.S4F�'f"'l}La Y5& Y Tn1F W �DI�F� ,� J rF7- £iL fiAYb_�xk<Poi t v""'. .., „... 1pl'F t}.Pe�. Tm¢q• 6U zt+a<M1 <• oaf.,:. h d� �„v:et�.� '�5� (, >ti u,c ''v�'n�i�r.�'. �i�C.:..}3f u' �,rnlnm�na� Poo C-�ehC�_1gtM,�' rla�.o65ro1 Mona war to e e orme un ert ispermrt-c ec a appy: OHVAC Gas Tank ❑Gas Piping ❑ Windows/Doors _Shutters Electric OPlumbing ❑Sprinklers Generator gRoof Total Sq. Ft of Construction: Sq. Ft. of First Floor: ,r; Cost ofConstruc ion:$q-3�(pCO.C7O Utilities: Sewer Septic Building Height: tOWNER,ESSE1 ;Tr�e4 �.,51,�•, ,ax..M1...«retH"'+�$_Z"nY+i.. 'vtl�t•ue }�.� 7h rCQNTRAC � .W.' vxw.� 'Au'.�. ��T E p '. 7�a , rJ; ,� r b.�I#. *'tom' •`.,r �ieJ'y�.1 - Name •La 1 ..� rit3 Ar'4+ 1,"fF� ,,kmi dt2 SG�V1�,". Name: S Address:D16ta- WfT}md Company: i" t City:PAkif. State:'• Address:", ZD (OVA Di tut(�2fi1 Zip Code• � Fax: City: \M bmich Stde: R - Phone No Zip Code: Fax:L401-N1'�L[� E-Mail: (40 If"14, OOfy) Phone No(71-12) -1-1- 1 • '61D55 Fill in fee simple Title Holder on next page (if different E-Mail: �'iUt i[Gpy1�OF111« If ^ �(� GfjGL( from the Owner listed above) State or County License: ©51a-�i If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. 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 Home Owners Association bylaws with any applicable rules, 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 commencingwork or recordingour Notice of Commencement. ` 7 �J ' St. Lucie Cour, �, FL �SU�PPIEIVIENTAL CONSTRUCT LIEN LAW INFORMATION � _ ? �. _ -,, , DESIGNER/ENGINEER: Name: Not Applicable MORTGAGE COMPANY: Name: Not Applicable Address: Address: City: Zip: Phone State: City: Zip: Phone: State: FEE SIMPLE TITLE HOLDER: Name: Not Applicable BONDING COMPANY: Name: _Not Applicable Address: Address: City: City: Zip: Phone: Zip: 'Phone: X � X Signat Lessee/ n ras Agent for Owner Signature o Co tractor/License Holder STATE OF FLORID STATE OF FLORIDA COUNTY OF �� COUNTY OF The forgoing instrum�ent vvyyas acknowledged before me The forgoing instrument oyes acknowlec)ggrd before me this day of OGL . 20� by this � day of GG� 70� by Name of person ma�statement. Name of person making statement. Personally Known OR Produced Identification � Personally -Known �O _ OR Produced Identification Type of Identificatio � Type of Identification Produced Produce (Signa re of N ary P rida) (Signa Lary Pub c-State of Florida ) MecCoy ARY�P ��� Frnmette Commission A� t(Seal) Commissio } NOTARY PUBLIC (Seal) Cam � BTATE O