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HomeMy WebLinkAboutBuilding Permit Application i All APPLICABLE IN//F��O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,t� Date: l�' U. Permit Number: l (0 0 6 • �y1� ] RECEIVED 1111111111111111110 Building Permit Application JUIN / 1 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 V i PERMIT AIPPLICATION FOR: PR®PfORSED INPROVEMENT LOCATO�N: Address: Af KE S� P zo Legal Description: �1du a�� Zr.a 74 S 9ZA_ Z07` Property Tax i D#: 3 f Sy0 ©.2,�?' 02 O O 0� Lot No. a2 Site Plan Name:eBlock No. Project Name: Setbacks FIront Back: Right Side: Left Side: D AIL © DE�SCRIPTI®N OF WORK: e: o I EM,NSTRUnTI e N INFORMAATtO : Additional Work to be performed under this permit-check all that appy: _MechaInical _Gas Tank _Gas Piping _Shutters _Windows/Doors Zlectric —Plumbing —Sprinklers —Generator —Roof Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ /00 Utilities: _Sewer _Septic Building Height: ME i R, ER AIT101 1 CO'NTRACTO Namee- &S �r Name: Address: Z��a �a aces �4' Company:.tom,/? X City: �9'-s i �.� State:;2E:� Address:.?�;'�/ lis � ��r�✓ C 8� Zip Code: Fax: City: State: / Phone Nod Zip Code: 373e�P Fax:.-5'e/ Ce' ° !Lri E-Mail: Phone NoJ'Zf/ Fill in fee simple Title Holder on next page (if different E-Mail r/ic e 7 ®o, C_- from from the Owner listed above) State or County License_,E7(::- 1300'T3�d I If value of c nstruction is 2500 or more,a RECORDED Notice of Commencement is required. SUR'PLEMENTAL C®NSTR�UCTI(JN LIEN LAW INF F- M:A I®N: DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLEtITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable Name: i Name: Address: I Address: City: i City: Zip: I Phone: Zip: Phone: I 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 CountyI 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. Si nature of Owner/Lessee/Contractor as Age Rgnature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA - `r= COUNTY OF COUNTY OF The forgoing instr ent was a nowledged bef o The forgoing instr nt was acknowledged bef this t day of 20j by z m� this day of 20_ by v E4-10 cTTii2— An) aio dr 9 (Name of person acknowledging) �° �� J(NameCofpl'pe'rson a nowledging) a;N Flu I IAA- 14A (Signature of N tV Public-State of Florida) (Sig a ure of N 0 VEY Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Ide%ifi ation Type of Iden ' ' tion Produced &a C, Produced C . I Commissio i NT (Seal) Commission N . (Seal) I REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 12014 i