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HomeMy WebLinkAboutwh appl.12.2.2016ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTER Date: Permit Number: J ` _- Building Permit Application Planning and Development Services Building and Code Regulation Division 2390 Virginia Avenue, Fort Pierce FL 34952 Phone: (772) 452-1553 Fax: (772) 462-1578 Commercial Residential Address: _ 3 95,v fl'43' I ' _POD Legal Description: POD Property Tax ID #: 33 -50 4 PEI -a,00" q Lot No. cz) Site Plan Name: Project Name: Setbacks Front Back: Right Side; Left Side: DETAILED DESCRIPTION OF WORK:1411,oAmel, t o f 5o ( ele—J?; Block No. CONSTRUCTION INFORMATION: Add tion work to jepertormed under this permit -check all that apply: HVAC Gas Tank F]Gas Piping 1_ Shutters Windows/Doors 11 Electric Plumbing i=iSprinklers F1 Generator F]Roof Roof pitch Total Sq. Ft of Construction.�T____._ Cost of Construction: _ f f% SFt. of First Floor: _ Utilities cn Sewer E]Septic OWNER/LESSEE: Name vyf;iC l I Address:; i�f� ! City; O _ '# _ C. State: F�- Zip Code: 5 Yq 9G Fax: Phone No. Mt%i 57 E -Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) CONTRACTOR: Building Height: Name:-)yY—G1 SNijc l`1a-"' Company: u 'r `J nC Address: QJ q A)w Q P—ein City: poll S4 Luc,, P _- State: Zip Code: 3 k q eC Fax: Phone No. `7701 -777-tip( E -Mail: -etk (._-a`-. (Y ! AC C) .. CDk-\' State or County License: C�6--_ Q q oe 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: Address: City: State: City: _—State: Zips: Phone: Zip: Phone: FEE SIMPLE TITLE HOLDER: , Not Applicable BONDING COMPANY- Not Applicable Name: Name: Address: 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 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 mast 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 k or recording our Notice of Commencement. s Signature of Conti ctor/License Holder Signature of O ner/Lessee/Contractor as Agent for Owner STATE OF FLORIDA STATE OF FLORIDA kc COUNTY Ol= (� COUNTY OF The fofgoing instru ent wa acknowledged before me �by The forgoing instrument n .!i acknowledged before me Dv bE4 6 by this d(� day of_ aw —, 20 this day of , 20 (Name of son cknowledging ) (Name of p sin acknowledging) (signature of Notary state of Florida j (signature of Notary P i ate of Florida) Ll"OR ZOR Personally Known Produced Identification !^ Personally Known Produced Identification Type of Identification Produced Type of Identification Produced.,,.. Commission No.Seal Commission No. Seal --- 1,7,kNk1KkN BAywoW riTZPATRYGK JCIfGirhil�llRd 9AYWfAG r1JT4@AyWQK �• MY COMMI$ FiSFt MESStott* F23S662 Revised ©7/15/201 ��..•, EXPIRES May 21.2019 s ,, EXPIRES May 21,2019S saCIt34Gi:'h3 FUrdaNaa Sarvic�.� IUtV�y4-i:"S3 Flor arvlce.car REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS