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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: �I�°`I�6 Permit Number: ,�� 1 0-M RECEIV7-:0 JAN 19 2016 Building Permit Application 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: Q, v�b•�� PROPOSED IN"{ ROUEM ANT LOCATIC}'N: Address: 11aAl Cad �f Legal Description: PropertyTaxlD#: � �l� SaaC�-�J�G ��� Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DET .PLED DE���RI�PTION OF 11VORK: CONSTRLICTICSN IN�F©R+ ATION: Additional work to be performed under this permit—check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric V"Plumbing —Sprinklers —Generator —Roof Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction:$ -L99S . U Utilities: —Sewer _Septic Building Height: OUI/NER/LESSE: CONTRA ®R: NameGjt�L�S Name: 0 2z �s % ��rzvrr Address: ��c L2�/a:�d� Company: f.,c/��� City: � � State: /:Z Add ress: Y,/7�/V W/air' ,W�4 9/— Zip yZip Code: 3�Too'�a Fax: City: A'e'k State./—,/"— Phone No. 7o�'aG/�-�9�5� Zip Code: Fax:,:7Z,? E-Mail: ///df��i��siu[a_'Gf�, C� Phone No Fill in fee simple Title Holder on next page(if different E-Mail from the Owner listed above) State or County License If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. S PPLEMENT L CONSTRUCTION LIEN LAW INFORMATi`ON: 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 comm k or recording our Notice of Commencemen J � S ure of er/Lessee/Contractor as Agent for Owner Sign re of C ractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF L-i COUNTY OF Ly C.yt The forgoing instrSLment was acknowledged before me The forgoing instrument was acknowledged before me this %N day of J A 20 AC by this %0�\ day of 7S'v n 201G_ by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Public-State of Florida) (Signature of•Notary Public-State of Florida ) Personally Known OR P odu.ced-f nE i (ti t�'�NS Personally Known ,,,,,OR Prod ucad' t ifi(Ron. Type of Identification "`�� o Y PU public state 0 �, Type of IdentificatioC��o�' �' Notary Public-State of 6,2016 Produced L L' ,.�� e�, Notary ices pec 16 2 produced 1`-'_ '�; •=My Comm.Expires Dec 16,2016 _r. * = y omm•ExP #EE 858761 Commission No. 'o emmisu�hNationa�e�y1A�s- '�9* , oma ondedThrougon oEENtary6Assn. $C Commission No. `�1r2 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.7/2014