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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: 176Z —,f2(-) f L _.m........ ,,.„_.tea ........ .............._.,m._ ....,.,,.:...._.....,.._,�, - 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: ipi -'ta 1 k'+� PROPOSED INPROUEMEIT LOCATION � a '` * ri r „,� Address: 2) a74 Rio c' Legal Description: Z L Property Tax ID#: Z Y 0 3 Yz2 d d C9 O z Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: nes w#� 'M��'�xy. :�Yh�S"ha•"�a�?4 s s r'. u. '.:� t � d:.. �,} xA� i TDE1'AII;EDDES'CL♦ I TI x NyOF�J'WORK f � � b Eli 00 t -. CONSRTRUCI"ION I1111 1 NFORMATLON �MIR� x , r �° �� ay a= ,�,<.�� r .:r .. c „. ,.:,�,-d� a �- „w - Additionalwork to be pertormed under this permit-check all that appy: Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors ElectricPlumbing _Sprinklers _Generator _Roof Pitch 1,_ Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ OOH,© Q Utilities: —Sewer _Septic Building Height: OUVNER%IES$ E "�� } � � t, CONTRACfOR Name V U- I L Name: ,J_,C Addre s: CID2r S•ei- 6 4 kaxtod esop _ Company: L City: S-( Lc t G Ci- State: t Address: u ) Zip Code: Fax: City: yPf� ) ur,a State: L Phone No. Zip Code: X15 Z Fax: -17 Z`-33-�;-—l6 3� E-Mail: Phone No 7 7 -7'LZl � ? Fill in fee simple Title Holder on next page (if different E-Mail VNci-6 ni I, i-06D_ from the Owner listed above) State or County License 15,/Q360 tZZ� if value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SlJ�P-PLEM�ENTAL CONSI"R�UCTION LIEN LAW 4N,F®RFIUiAI"LO.N w 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 opAhe jobsite before the first inspection. If you intend to obtain financing, consult with lender or an atto ey before commence work or recordi_Dg your Notice of Commencement. 119 Signat re wn /L ee/ ontractor as Agent for Owner %nat� e of ntr r/Lic Ider STATE OF FLORIDA STATE O FLORIDA COUNTY OF S �� 4 COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this�2N day of 7- 120_0 by this day of , 20_ by P � (Name of person acknowledge ) (Name of person acknow edg g) _ Signature of Notary Publ -State of Florida) (Signature of Notary Public-Sta 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 ev. 7/2014