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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED / `1 (� Date: -�� �o Permit Number: / /o�" V"T r } e t'7 RECEIVED ` Building Permit Application DEC 2 2 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: Ve r4 a bloY) PRO 11871 INPROUEM'ENT L©CATIQN: Address:_107.z� S VC earl dr. * 163 J ensel &4CA,ICL. 3 y9r5'7 Legal Description:_ ��/�` / 0� q 1-/. /,/C�C 3,2,23-,2 5_'/0 Property Tax ID#: 7�1� ' 3-01- 0,2 5-<7 -00' 9 Lot No. Al Site Plan Name: (J�./1� 4V 04) f Block No. Project Name: Setbacks Front Back: Right Side: Left Side: D ITE ILER)PT10N aF YIVORK: 6/0 ;A rODI�'► i CO'I��TR+UCTIQN i.NF©'RIVhATION: Additional work to be pertormed under this permit-check all that appy: Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors Electric _Plumbing _Sprinklers Generator _Roof Total Sq. Ft of Construction: / Sq. Ft.of First Floor: Z�� Cost of Construction:$ Utilities: Xsewer _Septic Building Height: OWNER/LE�S�SEE: C®,NiTRAC�Ti®�R: Name '&*g than ri Name: r►'! �M%/ `i Address: 703 Jr F-WmDrf I't Company: . y,, Sial �o�c SVC. iHc City: �4,0 i State:W,6. Address: .41,c- SOON�f'r Sf- Zip Code: 680 yd Fax: City: Joh -en Q cState:F11- Phone No. 9'12 '.3a2 - 961q Zip Code: 3V 95-7 Fax: 772-2,3,2-,21 E-Mail: Phone No 77 0 -37/h Fill in fee simple Title Holder on next page(if different E-Mail �i ce ars S"/�r%Ji'�ij i d1C�4 �/G`io0•cora, from the Owner listed above) State or County License 5-/<7V If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SIJPPLEMENl'AL C®'N'STR;IJCTION HIEN ggW INFORMA►1"ION: 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 recordingyQur Notice of Commencement. Signature of Owner/Lessee/Agent (/y'�j1y= Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF im� g xC-)a The forgoing ins. ument was acknowledged beforE The forgoing instrumgot was acknowledged before ff MEcd this ay ofJ) 2V - by this.2;�Slay of 26/ by . se P3 v OR= v Wo= vFa= c �z (Name of person acknowledging) 4 �N (Name of person acknowledging) (Signature of 66tary Public-State of Florida) (Signature of N ry 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.