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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l Date: ( ' Permit Number: [ b-0 f� RECEIVED MEOW Building Permit Application SEP 2 9 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: PROP©SED ['N.WROVEMENT.LQCATIQN Address: S Legal Description: Property Tax ID#: -IZIQV".41 l� �- (01�__q 1 0 0- �p Lot No. Site Plan Name: /L Block No. Project Name: LLa Setbacks Front Back: Right Side: Left Side: DEl`AILED DESCRIPTION OF WORK ,.,. �. `4- CONSTRUCTION INFORMATION ` F 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 Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction:$ 0's-0 0-V- Utilities: _Sewer`._Septic Building Height: 01NNER/LESSEE Name V e Name: 17 d.)�s P . Address: I'S h4t . Company: City: D 12 1 e State4 JA Address: Zip Code:"'�'kl 0 T 2- Fax: City: State: Phone No.T�-, (a I, I s:• Zip Code: Fax: E-Mail: 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. SUPPLEMENTAL CONSTRUCTION LIEN LAW INORMATIQN T.'l a 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. Lerol=ia Si • atu�re of,Owner/Lessee/ ontra for as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF,FLORIDA COUNTY OF COUNTY OF The forgoing instru ent was acknowledged , ..e. The forgoing instrument was acknowledged before me this day of 20 this day of 20_ by Ra, n 0/l Ci.9 a m< ame of person acknowledging) G o o (Name of person acknowledging) a mg Q vw�x �c (Signature of o ary Public-State of F46rida (Signature of Notary Public-State of Florida ) A �N Persopa4l-Known OR Produced Idtifficatio Personally Known OR Produced Identification Type f b tent' Type of Identification Produce �/1` Produced Commissio (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. //2014