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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED v� 1 Date: �— /� ^ f Permit Number: / d�'- / 0 .. `�� RECEIVED Building Permit Application Planning and Development Services JAN 11 2017 Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 X Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: i h . P {� 'OSE ► I P'RO fMENT L©CATION: Address: rT/ 3�0�( Gwl V1 !/ Legal Description: Property Tax ID#: S Lot No. 3 l Site Plan Name: Block No. 3 8 Project Name: Setbacks Front Back: Right Side: Left Side: ng_ �o -Co � AddC�0 'STRUCT O NPORM TION Itiona .wor to a pe Orme under t Is permit-c ec a tat appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors Electricumbing _Sprinklers =Generator _Roof Pitch Total Sq..Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ Utilities: —Sewer —Septic Building Height: 0 NS ER LSSS CON RACTO Name Name: vmw i N Address:: 40 67 N4_ 7-"� r Company-' City: P � S • L:_-_ State:_ Address: I-70 lkle ccj r_ Zip Code: 3 4-9 9 3 Fax: City: V.V'Cl )'�-ecc-L State:`1'L- Phone No. - $$ J& Zip Code: 3Z_q% 2 Fax: 7 7u- y� E-Mail: Phone No/ -7 7 e- 3 / 9 Y Fill in fee simple Title Holder on next page(if different E-Mail h�ei s1 y-e-r'o LO 1pc( (Sw �- from the Owner listed above) State or County License L-CE o Y-g -Z-73 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. WU P ROIANW&LLSONS TI • IE UM OR MORMATIlJN. 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 thepermit holder to build the subject structure which is in conflict with any applicable Home Owners Association-rules, bylaws'or and covenant's 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-residentiakuse WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for improvements to your pjji�st rty. A Notice of Commencement must be recorded and posted on the jobsite before the inspectif you intend to obtain financing, consult wit lender or an at rney before commenc• work or rerdin our Notice of Commencement. Sig ature f O r/Lessee/C tra oras Agent f �: Sig ure o ntrac /License Holde a� c ao ' STATE OF FLORID _ °�P�; Rr` STATE OF FLORIDS�. COUNTY OF COUNTY OF SL X�D -4:220 C The forgoing instr�9rent was acknowledged befor m m The for oing instr nt was acknowledged befor f 5 this day of ((�� 20�by �N W this day of A 20/7 by ��m w 0 2 ?C /I Z DI c �T (Name of pe on acknowledging) a;N (Name of person acknowledging) jN a (Signature of Vtary Public-State of Flori ) (Signature of N vy Public-State c 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 SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW - REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.7/2014