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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: yr d f- , (p Permit Number: Q a Building Permit Application APP 2 12016 Planning and Development Services F'?vii?TINC3 Building and Code Regulation Division :::ia County, FL 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: PROPfJSED INROVEMEIVT LOCATION ` Address: Q 61-5 mc- N"'I ad Legal Description: Q �I ` Property Tax ID#: "Q ©0 1 ' `1 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK sVW lav, A-O 6452_( k; CONSTRUCTIC}N INilFORMATICt,N o Additional work to be pertormed under tis permit-c ec a t at apply: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric ✓Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: 0 Sq. Ft. of First Floor: Cost of Construction: $ 601 Utilities: _Sewer _Septic Building Height: OVt1NER/LESSEE CONTRACTOR i , a =. Name 1' WbF-r•ah Name. Address: mc_�3Q la Company: City:'-F?i QrC Q, State�-L Address: Zip Code: J"'Ig5 Fax: City: State: Phone No. '1'7Q-F,2 - 1)5: Zip.Code: Fax: E-Mail: L hone No Fill in fee simple Title iolder on next page( i different E-Mail from the Owner listed above) State or County License If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SURPLEA MENTAL CQNSTRUCTION LIEN LAIN INFORMTION , 8 DESIGNER/ENGI NEER: _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 conflictwith 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. Adiffil _1� 'An 0)(1�xz Signature of Owner/Lessee/G. ractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF 5 LtAc,)e COUNTY OF The forgoing instrui ent was acknowledged before me The forgoing instrument was acknowledged before me this day of i 20 10 by this day of 20_ ,by (Name of person.acknowledging. .;.. (Name of person acknowledging) (Signa ure of Notary Public-State of Florida) (Signature of Notary Public-.State of Florida) Personally Known OR Produced Identification f Personally Known OR Produced Identification Type of Identif'ca 'on Type of Identification Produced •i'1 =�e KAREN S. NI�Lrpd Commission#f F 'I'15G37 {3 Commission No. 'J _R )tr= my Commissioneornmtssl No. (Seal) June 12, 018 i .�..�'e 11111\\\ �6t31i.+� REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.7/2014