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HomeMy WebLinkAboutBuilding Permit Application i l All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ! r _ f Date: Permit Number: I CSI:I " 04LO Building Permit Application NOV 18 2616 Planning and Development Services r, E Building and Code Regulation Division St.Lucie COj:' h 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: I PRGPOSED INPR01/EM NT 'LOC Address: ���L�� ILI, I Legal Description: Property Tax ID#:17J l' 7 O I ' ©��P`1 �nl��D I Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Sidd: " f DETAfLEb DESCRIPTIQN QF WORK• -'--TN . r w _.. I I a CUISTRUCTION "1111 I '� 1NF ' r itiona workto a performed under t is permit-c ec a that appy: a _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric _Plumbing _Sprinklers _Generator ' Roof 2 Pitch Total Sq. Ft of Construction: U Sq. Ft.of First Floor: ! i Cost of Construction:$ ,�'� Utilities: —Sewer _Septic Building Height: OWNIER/LESSEE CONT tACTOR. ,..8.4. A Name (1)b' AiT.WS ' Name: i Address: •,�-3C)L Company: City: rf;aefG" State:U-- Address: is Zip Code: 5'S�G Fax: ['77Z� 5w�SG� City: I State: 1: Phone Nz �ry• U�•g-� Zip Code: G Fax: �1 : E-Mail: ,(1�;�, —Zcz> T-� 10'5"7�r� � � ��=-� of ,, 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 icense .If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. I � SUPRLEMENTAL CONSTRUCTlQN LIEN LAW I F:, RMATIQN J DESIGNER/ENGINEERApplicableMORTGAGE COMPANY: _ N _ Not of 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. S gnature of Owner/Lessee/Contractor as Agent for Owner; Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OFA_ COUNTY OF The for ping instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of Kh) 20_(( by this day of 20_ by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Public-Stat of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of I entific do Type of Identification Produced 1� Sa''�(�l '� 0 `:� Produced LAk_ANA INGflAM Commission No. �`"���""'' Notary t��jj �State of Florida. . Commission No. (Seal) My Comm.Expires Dec 20.201 6 •. * - 177249 REVIEWS F N� `� 4EVI rough ationalNotaryAssn.'�����"' PLANS VEGETATION SEATURTLE MANGROVE CO EW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 7/2014