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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEq Date: Permit Number: Building Permit Application d 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: PRQP®SEII I1NPWE,EMENT Address: 9 a7,:S c X _zlVG �• tr / ���6 7 Legal Description: 41 � r� Le 76,21 l03 Property Tax ID#: L'�ad - �Sv Lot No. Site Plan Name: lie ine Block No. 12 Project Name: 4,7a-e �E'S�� Pe5i Setbacks Front Back: Right Side: Left Side: • I DETAILED D€�-SC PTION O WORtK: Z rr =@@N-STRU_CTI©: LNFOR+MA ION; Additional work to ._be performed under this permit-check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors _Electric _Plumbing _Sprinklers _Generator _Roof Pitch. Total Sq. Ft of Construction: Sq. Ft.of First Floor: ` Cost of Construction:$ /,;Z Utilities: _Sewer, _,Septic Building Height: OWNER/X-88EE: CONTRAC 0'R: Name Name: /6-%4`r Ile A-&14 Address: Alii-.,.oG� �Ah� Company: 'ri�rh /1�e�se ! vh52Zs3�io� City: a��, ��r�e State: I- Address: aZ A Zip Code: 3 Y7Y 7 Fax: City: /�/. ;i- � c�r�e State: Phone No. 77- ,Z/6— / � � Zip Code: 3 Y'9Y '; Fax: E-Mail: — Phone No 7T,,z. -aZ '/"3 OF Fill in fee simple Title Holder on next page (if different E-Mail he&,11, rii� VaIr'. Cel" from the Owner listed above) State or County License' I<T 4�_, -14A7 9�- f " If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUP'PLEM'ENTAL CONhSTR'UCTI®N L1E�N LAW I FOR=MATIdN.: 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. Arl t:xZ Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License older STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing ins ament was acknowledged before me The forgoing instrument was acknowledged before me this J day of AQ ID 20_0 by this day of ,20_ by (Name of person acknowledging) (Name of person acknowledging) Aigature of Notary Pu lic- to of Florida) (Sb ` ure of Notary Public-State&f Florida) Personally Known OR Produced Identification Personally Known— -ORRroduced�ldentifica-ionz-" 2 Type of Identification _ Type of Identificatidn,,,.�adY�Ze-,, LASHAHP.A IIJGHAM Produced X1 ,1 ,,,, HAHNA INGRAM Produced �. ;°� Notary Public State of Florida ri _. , i pires Dec 20,2018 Notary Public State of Florida N1' °oma; Commissip� #f1F 177249 Commission No. •'_My Comm(S's�l�jes Dec 20,2018 Commission No. %'�oFF° nded througflld�ti�AAI Notary Assn. Commission# FF 177249 I` Bonded throw h National Notar Assn. REVIEWS FRONT uZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.