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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 u Date: 3.a Permit Number: zc-1 -0 0 Building Permit Application 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' P SED IN:P�R1nO� e MEyNT LOCA#TI/ON: � Address: Q©O G`��-t f �'� �i�1 Vii -f'�. �b e.(�Ce., El Ca?1K-* -- Legal Description: Property Tax ID#: a'� %6 4&, Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: D'E /AILED DE-�SCRfPTI01V=�O.F 1NORK: GI 1111141" 11 1,1111 CO'NSTRkJCTI°ON INFORMATIONMOM Additional work to be performed under this permit-check all that appy: _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:$ �� Utilities: —Sewer —Septic Building Height: 01NNE%LES"SEE: „ �CONTRA'CT®R: Name Name: Address: Company: City: State:l=L Address: Zip Code:3!y CLg a-- Fax: City: State: Phone No. 71 a`-!4`G` :7j!P4 Zip Code: Fax: E-Mail: Cbl Phone No Fill in fee simple Tit a Holder on next page (if different E-Mail from the Owner listed above) State or County License LIf value of construction is 2500 or more,a RECORDED Notice of Commencement is required. Sl1FP'LEMEN AL CONSTRUC�ITI® LIEN. LAW IN�F®R,I�I/�TL®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 o Notice of Commencement. Signature of Owner/L see/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me thisaa day of —3�)I�!j 20�6 by this day of 20_ by 6iR,b\0y (Name of p1drson acknowledging (Name of person acknowledging) (Signature of Notary Publi -State of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produc d.lden"" wAs Personally Known OR Produced Identification Type of Identification � 43 �E �state ' Type of Identification Produced 1' v'P''' Nolacy Public pec 16.2016 YP ��_ �,��, m Expires 61 Produced 4C'omm`ssion#EE 8587 Assn . Commission No. L .`°< ° 1S°�� oughNal+onalNotary 4 ommission No. (Seal) 11"F e �' BONI w REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW, REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.