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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUS BEOMPLETED FOR APPLICATION TO BE ACCEPTED q //�� r ' Date: 16 Permit Number: C)I A 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: RO:IMF SED INPRRA I M E ° NT L,�`CATIdN: Address: r) 3 5 Q �,+ S N�1 4 Legal Description: Property Tax ID#: SI-1 al-k 3VI- UDC' - 010"14 'Lot No. Site Plan Name: 71 , 012k Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED D CSCR+IPTION t ;F WORK: . 12- X/5� ,Roll (/M�,��'• CONSTRUCTI® INF©RMA ION: Addiflonal work to be perrormed under this permit—check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Constructioon:1 Sq. Ft. of First Floor: Cost of Construction:$ J b d`Ib D Utilities: —Sewer _Septic Building Height: OUVNfER/LESS E: ` CONT RACI'OR: NameSX\1 1V.. wg k> (V,:\Ec� Y Name: Address:1A%5 n s U S l\kuu I Company�p���1s�s -���PS� P�1�10ti QUbtLS City: �)V CLT . W C i -,— State: �:-t Add ressPl)o�SUy'�a%\�Woe& M— Zip Code:3-lgU Fax: 8nq 0a I City:QOq:-V SZ,We ,.c l Stater Phone No. �'1 01 OW\ Zip Code:INC\u Fax: E-Mail: - Phone No �j,ry5-L)yA r\ Fill in fee simple Title Holder on next page (if different E-Mail \F tV W Q�2 Wv\•C�m from the Owner listed above) State or County License %�WA If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SIlRPI: ENTAL NS 'R IO;N I:I,EN 'W 1fQtlul �Q 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. Signature of Owner/Lessee/Agent Signature of Contractor/License Holder STATE OF FLORID STATE OF FLORIDA lz>_ COUNTY OF � COUNTY OF -� The forgoing instru ent was acknowledged before me The forgoing instru elnt was acknowledged before me this day of C �y 201j, by this ' day of �L:i' 20JL by l i1"� i till (:.:i @/ 0I r L •k f r" (Name of person acknowledging) (Name of person acknowledf.- ge ) 15ignatur-e--o#Nota yP-,u ic-State of Florida) (Sign ture of Nota Public- Florida) Personally Known OR Produced Identification c�J Personally Known OR Produced Identification Type of Identification Type of Iden_tifica iLon Produced �� �Y�� y�rC ( ,S C�,1`c_- Produced rL 1-1,(1 ldr��.S COLLEEN DEMERS COLLEEN DEMERS Commission No. PUBLIC a T Commission No. FY PUBLIC o OF FLORIDA j, �S7ATE OF FLORIDA Comm#FF065960 Comm#FF06596o 1 s L"1� ExPil es 10/24/2017 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.