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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE I)N O MUST.BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: C �(�✓ Permit Number: & 1 , RECEIVED Building Permit Application SEP 16 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 PERMIT APPLICATION FOR: PRC}PQSED INft"E' MENT L,0•CATI4lU- .. ...-r . .-y... Address: �3 �a !�f Pi r r 1EL -TY Legal Description: Property Tax ID#: 3 oz © s( Lot No. Site Plan Name: Block No. �^ t Project Name: 0 .Lyl �Q1,1 Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION DF WORK' ® r CONSTRl1CTION INFORMATION Additional work to be pertormed under this permit—cfi—ec-k all that app.y: _Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors Electric _Plumbing _Sprinklers _Generator Roof Pitch Total Sq. Ft of Construction:: Sq. Ft.of First Floor- Cost of Construction: $ Utilities: _Sewer _Septic Building Height: OtfNER/LESSEE, ` miCONTRACTOR a 4 Name (en u- Name: Address: n S� ea Company: City: �OE� State.: Address: Zip Code: cr? 9 Fax: City: State: Phone No. r Zip Code: Fax: E-Mail: &-o"Whoul,4 Sa 1174 .e0 Phone No Fill in fee Vmple Title Holder on xt 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. a SUPPLEMENTAL CONSTRUCTIQN LIEN LAW°INFORMATION 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. {gnX •atur.,e�of Ouvner/Lessee/Contractor as Agent for Owne Signature of Contractor/License Holder STATE OF FLORIDA - STATE OF FLORIDA COUNTY OF COUNTY OF The f9rgoing instruniont was acknowledged before me r, he forgoing instrument was acknowledged before me this / day of - 20/V by his day of 20_ by 0 (Name of person acknowledging) �� Name of person acknowledgingdid- ) � wg IT g�u fi• T C�T �v (Signature of tary Public-State of F orida) `Oa Signature of Notary Public-State of Florida ) Personally K n OR Produced Identification ersonally Known OR Produced Identification Type of Identifi ioA1 Type of Identification Produced Produced Commission NV (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.