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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: > �-� I(0 Permit Number: r ED EE-1 ft Building Permit Application MAR 2 8 2018 Planning and Development Services Building and Code Regulation Division PER SII?-fii�G St. uci�County, FL 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: 1 V 1 ""IefL tA VAC PROPOSED IN.PROVEMENT LQCATIO`N / / Address: .' //7 �G( l/c.`'C �? yL� `7_ �7" �� f' L 3L_K Legal Description: i /�C� �( I\f ;'44-� Property Tax ID#: � ^ ©V�� d�J Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: 9. DEiT.AILED,DESCRIPTION'OF WORK P 9A TM t� Qf CONSTRUCTION INFOR'M4TLON } Additional work to be pertormed un ert is permit—Check a 11 tat appy: Mechanical _Gas Tank. _Gas Piping _Shutters _Windows/Doors _Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construc Sq. Ft.of First Floor: Cost of Construction: $ � ( � Utilities: _Sewer _Septic Building Height: OWNER/LESSEE ;r CONTRACTOR Name i 41i Name`: c Gwl r Address: 5 �12i �Y/���ai� , '��_ Company: 'r �c�c'a� 0;A-` h City: .� v r "'G-C e State:C� Address: Z-91� St c1 1 USl�` �'A- Zip Code: Fax: / City: I��L State: I` L Phone No. �► _ ��, L� �l f� Zip Code:_ ��4/ TE Fax:_(77Z) 97!©31 0 E-Mail: Phone No 72-) F? r e` 2 Fill in fee simple Title Bolder on next page(if different E-Mail • t I� ` u d °� from the Owner listed above) State or County License �A� 13 911 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL 7', LIEN; LAV1/ INFORMATION .. __.:: .._ .. .,.x ...a..::._,. ..,,<.7.,..... ,.: .__. rig.... .,,...:.x. 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 thepermit 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 Commencemen Signature of Owner/Lessee/Agent `rgnatur ' Contractor -rcense H der STATE OF FLORI STATE OF FLORIDA COUNTY OF F COUNTY OF C>4 > / The forgoing instrum was acknowledged before me The forgoing instru 13t was acknowledged before me this day of /fL f{ ;20 by this day of //J-Ifs 20)&by __._ _. Jim imn (Name of person acknowledging) (Name of person acknowledging) (Signa re of otary"Public-State of F ida) (Signatur of Notary Pub ic-State of Florida ) Personally Known OR Produced Identification Personally Known / OR Produced Identification Type of Identification Type of IdentificatioJ� Produced �� Produced A/✓ Commission No. // (Seal) Commission No. B (Seal) REVIEWS P R ISOR PLANS V ROVE REVuIEiWSA J. Plc REVIEW E�Ff 28-, 1r3ItV"VV SPICENAssn. IEW DATE *°: Notary u is-State of Florida " _ of lo Ud t •: .�• M Comm.Expires Feb 1RECEIVED �' ��; Y Comm.Exp(res eb 1t,2019 ;�+ a. mission*FF 171, DATE /FOFF��p�� � •` Bo dedthrough National Not " "• ondedthrough Natio INotary Assn. COMPLETED Te—V-7772-L)14