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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: X643-b`�ot� - �- � RCI" 2016 t� MAR 3 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: r ,� „t,� PRt7P©SED INI'ROUEMENT LQ.CATtt7N: Address: G �a-lez) 3 gS al Description: 1. Property Tax ID# ' �Z. �6 - Lot No. Site Plan N e: Block No. Project Name: ,e 4,yeo Setbacks Front Back: ,Right Side: Left Side: DETAILED DESCRIPTION OF WORK: CO "rt STRUCTIQN 1NFORM�ATI©N: itional 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: 027 Cost of Construction:$ Utilities: —Sewer _Septic Building Height: OUtiIN IIVER/LE�S�SEE: CONT'RACTO'R: INA Name /j',-- e, `i=}-�l�.s� Names �,. �LJ��fi i� Address: Company:-,'. City: ` State:,�(�2,:' Address:.:,C � ' lY�O.i, TGA Zip CodeFax: City w���' °"' State �A Phone No. 06 �5�' ��°I Zip Code: 3V Fax:-) ,Z' ZS- -;"1 ,Y E-Mail: Phone No –717-- 0`/ O/ D>3 F'II in fee simple Title Holder on next page (if different E-Mail �S�Be -7 C.040fro thState or County License _ s I v lue of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENl`AL.CO S�TRUC. ON LIEN LAW I , -®FtMAT10 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 Commenceme 1A I])-A I )J A" Sig u Owner Lesse gent S' re of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA. COUNTY OF COUNTY OF The ing instru nt was acknowledged before me The for oing instr ant was acknowledgefl before me th' day of A�C� 20/rrby this/ day of A7QC-,1 20YG by (Na a per on a wledging) (Na f pets ackno edging) Signature of Notary Public-State of Florida ) (_',(#n;Aure of Notary Public-State of Florida) Personally Known— OR Produced Identification Personally Known 17� OR Produced Identification Type of Identificatidh Type of Identification Produced Produced Notary Public State or Fbrida Commission No. L146&6erBharath Commission No. ° N @V�PiicSteteotFrortda My Commission FF 962709 LIS r r Bharath or Expires 02118/2020 My Commission FF 962709 WM/ res 01218/2020 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.