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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i Date: 1��J `� Permit Number: � � m" RECEIV7D rats;' 03 2016 Will >- 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: 1 �"r ;G q PR6'aPf�3SE(� INF'R01/E �EN ALO ATICIN-. �" Legal Description: Property Tax ID#: I-_Z4` OV"CM/7 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side:r Left Side: Eo (:HAI, 1NC- gr4,-- z 517IF-5 0J 30V A 2 H4NhLFR5 - �6IM6 1715�--omirrT ©,i &)Jt�=MSt% Uo T &141,►61M6 13f 1 517 DN. 2 &pf):1v5I&Y, UlulT COnSTRUCTIONINFORt\/IATI®N 6 �� � . :M:a[i k+ t•9iF :a eel '{ .,:;a;:: ., ti sr'.i� „•'4s'±P.C;arc'�Pq�' as .0' rtiona work to a pertormed under this permit-check all that appy: 'Mechanical gechanical —Gas Tank.. _ pGas Piping —Shutters —Windows/Doors V Electric Plumbing* Sprinklers Generator Roof — — — — Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ .W Utilities: —Sewer _Septic Building Height: „�:: 7 r �t {.•�„ v -'. ®U�INEEt:LESS E ry: a � ' CONTRA � . � R. � w . � i .r Name" ,��f�/li il/C� Name: Address: . -7iy 97. Corripany: 6j���Lb�T1Zl� CP. ty:. i .p�e�c.c --..._.....; State:— Addiess: 7N R,. Zip Code: Wf'S—/ Fax: City: Fbi;L-r 1e�� State: FL Phone No. -772- - 2 /,, - 3G � S Zip Code: 34951 Fax: E-Mail: UyFLc el/-iI Iu,&­-, 6--� 4-0L •copy Phone No M 579-P 9 Fill in fee simple Title Holder on next page (if different E-Mail 5AV5W1CM5& am from the Owner listed above) State or County License 5�-15D0692S If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. ii 11 EiIV1EN�TiI.C®N5�1 xG IO t C . uv N' oJRlVIAT1N: �, �a a . 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 commencin work or recording our Notice of Commencement. 0-44- /�—Vwe_� RE Signature of Owner/Lessee/Agent Signature of ConfA nse Holder STATE OF FLORIDA STATE OF FLO COUNTY OF 5�777. L-v COUNTY OF s T- Z— The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me this-_5-day of Ny✓ 120 IA'by this "day of 20%b by o L.,r, A, (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida ) Personally Known ✓-SOR Produced Identification Personally Known OR Produced Identification Type of Identificat on,,..,p�p�„ Type of Identification Produced '�`'"'"`"4: MICHELLE ANN MILES :_; �, Produced ? „; MlrHELLE ANN MILES MY COMMISSION#FF045346 MY COMMISSION#FF045346 Commission No. '' oFo? EXPIRES S ��er 15.2017 Commission No. PrP EXPIR&AIItember 15.2017 (407)398.0153 FloridallotaryServioe.com (407)398-0153 FloridatJotaryService.com REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 712014