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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE NFO YUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: ©� l �� Permit Number: q��y�[`y�� REG I Vq`yp{�]gEi Building Permit Application JAN 12 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 i PERMIT APPLICATION FOR: PR®POSE© INARUEM,ENT LOCATIaN: -� Address: /--6 ,3 - Legal Description: Property Tax ID Lot No. Site Plan Name: Block No. Project Name: +41Ji1�,J Setbacks Front Back: Right Side: Left Side: D TAILED ®E�SCRIPTI.®N ® g'WO ' K: a� CONSTRUCTION I:NF®'RgIUTATlO.N: Ell 0- 111111111111111111iff-M rtioa wor to a pe orme un er t is permit—c ec a tat appy: —echanical = Gas Tank _Gas Piping Shutters _Windows/Doors Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction:/ Sq. Ft:of First Floor: Cost/of Construction:$ /(���(%� Utilities: '—Sewer —Septic Building Height: (JWN aIJI -�SISEE: CONTRACT®R: Name ,t1rtJ Name: Address:. Com p an Y: City:ront.�C.t� Stater Z._ Addres Zip Code: Fax: City: S State: Phone No.(}e?�,,J aos—/C�O3 Zip Code: Fax: E-Mail: Phone No 57_-II — Fill in fee simple Title Holder on next page(if different E-Mai C® from the Owner listed above) State o County Licensetl � If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION L{SEN LAUV I'N'FORM TIO 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 first inspection. If you intend to obtain financing, consult with lender or an attorney before commencing work or recording our Notice of Commencement. Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF NTY OF The fomoing instr9skumt was acknowledged before me The forgoing instrutz�etrt- as acknowledg d before me his tI okay of � 20�by this�ay of 20T�jby _" I 1�� l 5 Xr*� VS ae,-S74� (Name of person acknledging) (Name of person acknowledging) (Signature of Notary P lic-State of Florida) (Signature of Public-State of Florida) ���OSAR �� Personally Known OR Produced Identification Personally K mc: OR PrmQdentification Type of id e` iYR 0 HU allies, , _ N' r ubli CA FF (� ANGFi 9 M Hu Produced I 'a` Comm/—,-Stat Notary Rublid. 111"` �'y Com sr��p3t Florida` '.« •°= y State of Florida " Ex4e70 - Ftt't (90MMlssiOn#FFa.1a7aQ (Sea l) Commission.No. BOndedthrou h�ato M of 3 )9 My cc m_M Expires May 27.2019 a', 1111111" Bonded through National"ro .. REVIEWS FRONT vZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER "'REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.7/2014