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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO /MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: RECEIVE® k7-, tk; N Building Permit Application JUN 3 0 1016 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: PRO_PO.SED INPRO NrT LAN; Address: .5 0.S e Legal Description: kElam© qg,< J16 6:;wl Property Tax ID#: Lot No. Site Plan Name: ZAK v6aa2P,dkkk Block No. Project Name: PA,&_ P6b2 Setbacks Front Back: /© Right Side: D Left Side: MMIO'N QF WOR 1C)CA ye.na(t_. tQ i :Tb)1 N .. CONSTR=UCTtON IN'FOR'MAI'ION; Additional work to be performed under this permit–check all that apply: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors Electric _Plumbing _Sprinklers Generator _Roof Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction:$ 1� ® ` Utilities: —Sewer —Septic Building Height: OWN=ER=/LE�S�SEE: CONTRA TOR: Name Name: Address: �o�OS� } ftSU Vales ��V Company: City: Ql. he.vice– State: ' Address: Zip Code: 3C}CIS Fax: City: State: Phone No. 6t�l� ����b�`�y Zip Code: Fax: E-Mail: JereY\ore _�e�)�ov�� . �" Phone No Fill in fee simple Title Holder on next page (if 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. SUPR'LEIUIENT�►L CONSTR.UCTI'®N LEEN LAW 1NF®RI.MMITATI®'N: 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 Commencement. ignature of Owner/Lessee/Contractor as Agent f r- - Signature of Contractor/License Holder b,' J STATE OF FLORID �° "'� ,,,,,, STATE OF FLORIDA COUNTY OF m COUNTY OF Xaa The forgoing instinjent was af knowledged befor :Bs 9 The forgoing instrument was acknowledged before me this day of 201b by u this day of 20_ by z �o LTi jJ' nth �1e� . a ^'�m ( ame of person acknowledging (Name of person acknowledging) a (Signature of Pary Public-State of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Iden ific i n �j /J,� Type of Identification Produced ' 0 r ✓�-� ( ` 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 ev.