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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED //, Date: 3 S f'� Permit Number: ( � 0 �S Building Permit Application ECEIVED Planning and Development Services MAR 15 2016 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: PROPOSED lNPROUEMEN LOCATION: Address: SOD s•(,t1, A ro5o ✓ �D r� S - �lcc C �t—, 3tF`�� 3 Legal Description: ��yP� y'wC� — CSM�? aS�-N Co K 3 Property Tax 16#: I& 3!�/ 0 00 — 000 — Lot No. Site Plan Name: Block No. Project Name: Z-1y2z Tdir k Setbacks Front Back: Right Side: Left Side: D T'AI�LED D€ASCRIPTION C}:F WORK: r �L v.�i Ci � �.is �... C a � �Lem �o' .tiL.\cam e•_ �\\pp e— [ Uz\�M !�:O cz C ZAA CO' STRUCTIO'N INFORMATION: Additional work to be pertormed under tis permit—c ec a that appy: _Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors Electric _Plumbing _Sprinklers ' Generator _Roof Total S:q,.:.Ft of Construction: Sq..:Ft.;of'First Floor: Cost of Construction: $ �Q d• Utilities: Sewer _Septic Building Height: OWNER/LEaS�SEE: CONTRAC OR: Name`.Se-t k-� . Nk.. ,' Name: 0o\`o ova i Address:-7-00 7 5kenc Company: City:l�oy{ �k LJex-s State: (— Address: u S•t- 2c-e ono_ CA- Zip Code: Fax: City: Llxc(e State: rr L Phone No. Zip Code: 3 V QC{3 Fa :770) g/00 —360 a E-Mail: PhoneNc� Z 0- 602 77Z-931/-8'�6 Fill in fee simple Title Holder on next page(if different E-MailA1�\mk e Ra- E1O(ic 1 0co-4c---,J_-ce from the Owner listed above) State or County License CK ('3013 1 (.d If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAWIFE,rffil JCTI®N LLEt� 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. Signature of Owner/Less ee/C tractor as Agent for Owner Signature of Contractor/License Hol er STATE OF FLORI - N STATE OF FLORI }CM . COUNTY OF COUNTY OF w^N The forgoing ins�nt was acknowledgeA befor r The forgoing instrument was acknowledged before o this day of � 20 (L by T o z this y day of 1 / 20Zr by } G- W L_lJ.l Z r� 2 ¢�W 1 �,©fid r S n ¢Ux 6 Uy }� a Y G (Name of person acknowledging) m (Name of person acknowledging) (Signature of NW ry Public-State of Flor da ) 77 (Signature of Not Public-State of Florida) Personally Known OR Produced Identification Personally nn&' at7 OR Produced Identification Type of Identificati . Type of Iden& n Produced a Produced C Commission No.U (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.