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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED too--,,•� Date: ) Permit Number: CSI lJ f RECEIVED ONE I JAN 2 12016 m Building Permit Application PERMITTING Planning and Development Services St. Lucie County, FL Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 v Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: ,�eG PROPOSED 11VPROVEMENT LOCATION - Address: Legal Description: Property Tax ID#: a��7D "j�a ` © _ OD�3 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: FU DETAILED DESCRIPTION`QF WORK` ` �; y "h 1 �i P P i<ctGe 2X%s7�%h 4 /�D We4er en c oV,-1,A&g Servicesy-i��r U/Ga�herf a # ter h , r a CONSTRUCTIO,,N INFORMATION ° _ x > . .: Additional work to be pertormed under this permit-check all that appy: _Mechanical _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: $ ��0,°° Utilities: _Sewer _Septic Building Height: OUVNER/LESSEEvM§CONTRACI"OR � ., . . Name of-S�;elefe k4l& Name: Address: 3TV y4ftln-rn Xd Company:,41IE/ecfe.� Con'�rac7�o/s�hc, City: F�-..Pierce' State: Address: g116ranrda- Zip Code: 3 V991 Fax: City: ��- Biei^cc? Stater Phone No. 37D -1173 Zip Code: )q5?y9 Fax: qK =-Z2_�' E-Mail: Phone No Fill in fee simple Title Holder on next page (if different E-Mail from the Owner listed above) State or County License 000 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. I I -) I q r1 SUPPLEMENT/ L%CONSTRUCTION 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 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. bTZ�5-- __ AS Sign A re f Owner/ ssee/Agent Signatur of ontrac or/Lic a Holder i STATE OF FLORIDA STATE OF FLORIDA COUNTY OF J A ICIECOUNTY OF l The forgoing instrument was acknowledged before me Thefo�oing instrument was acknowledged before me this a( day of 20.!a by this �� day of 20 jLoby �OVVY-ip\77"�,v�v6-i-pRe �Ip VVNJ �,b PLP�IJ ( me erso acknowled ing) (N m of son a knowledging) (Signature of Notary Public-State of Florida) (Signature of Notary Pu lic-State,of Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification f Identification Produced KAREN S. NIELSEod ed Commission# FF 11 637 c '" +O A Commission Ex it s Commission No. ;9 'a, albY (tom fission No.- .•��';o'�� , 5 J)N S. NIELSEN June ° 12, 201 Commission# FF 115 63 7 � Q My Commission Expires Jitne 12, 2018_ REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION G VE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.