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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: ��- �D Permit Number: z&— &— site �'� EIV ® _. .x Building Permit Application DEC /g 2016 . 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: Dee"?O-L T, 0 I\/ R©P�SED INPR©UE�MENT LOCATION: Address: _qor� Pkel-11r, ellz ,6 Legal Description: 45�11GLIPAL' /1 7712f etr5CW2V� Property Tax ID#: ���— �Q� � — D0� Lot No. Site Plan Name: Block No. Project Name: _&5tS T Abb Z1170i 11w-T--Y-f AN Setbacks Front Back: Right Side: Left Side: D TA D D 5 «R PTO O ORK: l cwd In fl'4/�Z�', g4i nj6 MLAI&IfJ� #1&16 /A D1�iCG- L;''Gl7 %LS2 PLC/,c�1B/2Jh CONS ON FORM TION• Additional work to be performed under this permit-check all t at appy: _Mechanical _Gas Tank _Gas Piping _;Shutters Windows/Doors Electric; _Plumbing _Sprinklers i..Generator Roof Pitch Total Sq. Ft of Construction: Sq. Ft.ofFirst Floor: Cost of Construction: $ / �' Utilities: —Sewer —Septic Building Height: 0 NER LE�S�SE CON RACTO Name APMES 061»ESEK- - k9e (L IbLus Name: 7_Rb�Sr— &zq3CWJ Address: U-3 UX.L&r,--bea Company:M& & IGOr2°S u& City: A'1 i-a-1.206 State: L' Address: �D11i0 SQJJ,1�1W1ff I-AIJ Zip Code: Fax: City: PdtfSrat6c State:FL Phone No. Zip Code: �jq9 6 Fax Z414P -&sW E-Mail: Phone No 'ZIPQC F Fill in fee simple Title Holder on next page(if different E-Mail�Si;p N46(esc CD bil l Sba,+h -ne from the Owner listed above) State or County License CGC If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL C«ONSTRUCTION LIEN LAW INFORMATION: 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. �AV144 Signature TOwner/Lessee/Contractor as Agent f Signature Contractor/License Holder STATE OF FLORI - STATE OF FLORID t- :*�• "0 COUNTY OF ' P4'* COUNTY OF The for oing instrument was acknowledged before The fing instru Ent was acknowledged beforthis�day of 20Lb by z 9 thisday of °� 20 LZ by m� t21 nSep j p a MKM 2:7- g 9 u f l ��1� ago m^1 g sse$ —. (Name of p son acknowledging) gp (Name of persona nowledging) �T C�T= tON � Ov fl'I .a4h*— (Signature o otary Public-State of Flori a ) (Signature of No a Public-State of Florida) Personally Known / OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced Commission No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 7/2014