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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: i ► - Building Permit Application MAR 2 4 2016 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: PROPOSED iNPROUEMENT L©CATION: Address: L/4 d e�1 Legal Description: Property Tax ID#: I `��- 3� /J6 --Ql�l��—�(JO�I�' Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION ®F WORK; /� CPtrw+:i� s'Gc�s/,�:•o3G C®NSTRUCT(�0'N 1NFORMATI�N: itiona war to be pertorme under this permit—clieck all that appy: _Mechanical _Gas Tank _Gas Piping . Shutters _Windows/Doors LeElectric _Plumbing _Sprinklers Generator _Roof Total Sq. Ft'of Construction: Sq. Ft. of First Floor: Cost of Construction: $ .S 0- U Utilities: _Sewer _Septic Building Height: OWNER/LE�S�SEE: CONTRA�'1'®R: Name .Name: 4-L-. Address: Company: City: State: Address: ed► L,4-/. -Ccs let,^ Zip Code: Fax: City: i ,f2 State: �� Phone No. ,�o�1 �� r �� ��f� Zip Code:?y C ce Fax: E-Mail: Phone No Ir Fill in fee simple Title Holder on next page (if different E-Mail 5T_1-6o., �(e�ir.� ®��!• �o.�. from the Owner listed above) State or County License 2 l y Z/ if value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL C«®NSl'RIJCTI®N LIEN LAW INFORMAl'IfJN: 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 commencipfwork or recording our Notice of Commencement. nature of Owner/Le see/Contractor as Agent for Owner ignature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF ;'' "A�. COUNTY OF The fo o'ng instrument was acknowledged befo "t ,'*; The for of g instrument was acknowledged fot a rrlre this Mday of0W�j� 20Z6 by a m< this ay of/ ��,�— .20 m�. x�a cT� Y3 20 S-1 N Cn ca (Name of person acknowledging) z (Name of person acknowledging) 3� C NO m �N (Signature o otary Public-State of F orida ) (Signature of Vary Public-State of Flori Personally Known e_/OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced Commission No. (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.7/2014