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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: c9• Ito Permit Number: r,. RECEIVED s - Building Permit Application JAN 2 9 2016 Planning and Development Services PERMITTING FL Coun Building and Code Regulation Division St. Luc , 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: PRfJPfSED 11NPROUEMENT LOCATIBN: Address: I ®& �Q /�� ate 40414le Legal Description: !YK-('/ /_ Property Tax ID#: Lot No. 2–' Site Plan Name: / Block No. Project Name: !C' U Setbacks Front Back: Right Side: Left Side: D TAILED DE�S�RIPTION ®F WORK: p CC}NSTR+tJCTI N INFORIIA1'ION: Addiflonal work to be pertormed under this permit–c ec all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _�ric -Plumbing —Sprinklers —Generator —Roof Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction: 00. 00 Utilities: —Sewer _Septic Building Height: O�IIIN�E�fR� Name /r� ✓ eV Name: Address: A$4 4050!- ^4 44• Company: C? � v� City: 'A-• JO/W& State:iq*• Address: 2i6- Z© 4-41c- Zip Code: 3 �01$8Z Fax: City: ' :1&cce State Phone No.__ 772 – ,d 4—577 � Zip Code: 3 4/9 p/ Fax: E-Mail: Phone No 2'^ .3Z3 Fill in fee simple Title Holder on next page (if different E-Mail -�Ce z–Q C from the Owner listed above) State or unty License, dl lvll� If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. mom' ' .+ 'CTION IGEN LAW I FORMATION: 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 ot..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 .eview:room additions, accessory structures,swimming pools,fences,walls,signs,screen'rooms and accessory uses fo 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 wor r recording our Notice of Commencement. 64,A� /Qi �� Signatur Owner/Lessee/ ent Signa re f Contractor/License Holder STA F FLORIDA STA E OF FLORIDA ' J COUNTY OF COUNTY OF The for ping instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of 20�by this�day of 24by (Name peron acknowledging) o N 1 t J N' (Name erson acknowledging) L1oul"14 ( i rJA 1 c1—� (Signature of NotaryPu)ic-State of Florida ) (Signature of Notary Public-State of Florida) Personally Known D Personally Known OR Produced Identification """' a of Identification Type of Identification _,,o�a.P�arn, KAREN S. NIELSEN type , Produced _ CommissionnFF115637.. Produced s•".PBS%, KAREN S. NIELSEN My Commission Expires 3, * mission.lf FF 115637 (sane 12, 2018 % EaFr��;oMyommission Expires Commission No. Commission No: 2, 20188 REVIEWS FRONT ZONING, SUPERVISOR PLANS VEGETATION. SEATURTLE MANGROVE COUNTER REVIEW ' REVIEW REVIEW REVIEW REVIEW REVIEW DATE, RECEIVED DATE COMPLETED Rev. 7/2014