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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 1 1 T�,�. Permit Number: • RECEIV'rD N0'! 03 2016 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 f/ PERMIT APPLICATION FOR: PROPOSED IMPROVEMENT LOCATION: Address: Legal Description: J �Gl�c�- l�\UPS U I, ` l� (In-g 7 L-0) 0)-,), Property Tax ID#: —� _ ©S� - UC>D— 6 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: CONSTRUCTION INFORMATION: Additional work to be performed under this permit-check all that appy: _HVAC _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric L'Aumbirig —Sprinklers —Generator —Roof Roof pitch Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ or) `=. Utilities: —Sewer _Septic Building Height: OWNER/LESSEE: CONTRACTOR: Nam6" 6�L ,e- .)C— FName:' Address: ti 1A(0eo S Company: 'Z. . ✓v�b. i City:. S(_ ;' State: 1`L Address: .�7 ( S� S US'. Zip Code: 3 Fax. City: O,( 1 l State: Phone No. Zip Code: Fax: E-Mail: q y a 3 F9 Phone No. 7 7 a—6c) l Fill in fee simple Title Holder on next page( if different E-Mail: from the Owner listed above) State or County License: C KC- I L4-,),q 3 h? If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: Address: Ad d ress: City: State: City: State: Zip: Phone: Zip: Phone: FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable Name: Name: Ad d cess: Address: City: City: Zip: Phone: Zip: Phone: 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 thepermit 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 comm ng work orj:pcording your Notice of Commencement. s Signature of wner/Lessee/Contractor as Agent for Owner Si nature ofC tri or/License Holder STATE OF FLORIDA / STATE OF LOR/IDA COUNTY OF ��, [-ls f; f' COUNTY OF -5/, The forgoing instrum nt was 4nowledged before me The forgoing instrument was acknowledged before me this)day of CY't r" "r 20 Lay this—'3 day of 20 IG by 6Zgt2/ -e (Name of p son acknowledging) (Name of perso acknowledging) (Signature of Notary bblic-State of Florida) (Signature of Notary Public-State of Florida ) Personally Known ✓ OR Produced Identification Personally Known vblOR Produced Identification Type of Identification P Type of Identification Produ 'c1!"r"'a=•. EMANUEL GAGE t"R""e ,EMANUEL GAGE Commission No. MY CC@4 Nf$ SION r'�.. oFtic : eIMISSION#FF027720 ` EXPIRES June 16,2017.:- EXPIRES June 16,'2017 Revised 07/15/2014 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS