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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: �' / Permit Number: A �� U U R �. RECEIVEI) Building Permit ApplicatiOgAN /5 2016 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: PROPOSEDlNPROUEM!E T L©CATiQ'N: NAM Address: 3114 MV Legal Description: 7,L-1k2-7 —LO — ©` 6��&9 Property Tax ID#: Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back:_ Right Side: Left Side: DETAILED DESCRI'PTION OAF Wi � RK: � � —S 3 CONSTRUCTION I!NFORMAT(ON: Additional work to be perform under this permit–check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors 'er Electric _Plumbing _Sprinklers _Generator _Roof Total Sq.:Ft`of Construction: Sq. Ft.of First Floor: Cost of Construction:$ C� Utilities: —Sewer —Septic Building Height: OU1lNE /LESSEE: Name t Name: T Address: 106 IaQ_ e�79l ee&6m pang: 2 Za ZO (e4 City: ��G I`LL State:_ Address: Zip Code: P Fax: City: State: . Phone No. --77—OZ$ Zip Code: Fax: E-Mail: Phone No Z-- z 3 v Fill in fee simple Title Holder on next page(if different E-Mail _ ��- from the Owner listed above) State or ounty License JEvalue of construction is 2500,or.more,a RECORDED Notice of Commencement is required. SIJPPLEMENI'AL CONtSTR CTI©N LIEN l.�W I 'FORM�►TtON: 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 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 fir t inspection. If you intend to obtain financing, consult with len r or an attorney before commenci ork qt-�ecording your Notice of Commencement. Signature f 16wn&/Lessee/Contractor as Agent for eer"A S Signature o Co actor/Li se Holder STAT O FLORID r a;;rt�' STAT O LORIDAb: z COU Y OF COU OF m The for oing instr nt was acknowledged before z A The forgoing instr ent was acknowledged befor e s m� this day of 20 bby o C,�Q this 1�day of 201b by ��o wC2 2 MSM c � n mc -p N r � C ame of person acknowledging) ; �N (Name of person acknowledging) N� N (Signature of oar ublic-State of Florida ) (Signature of Nota r ublic-State of Florida) Personall Known OR Produced Identification Personall Known OR Produced Identification -- Type of I enti cati n //)� Type o Iden ' is ion Produced `tXJL Produced Commission (Seal) Commissio No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW. REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.