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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 41117Permit Number: Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 �`'lj Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential Maw Y1 PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSE© IMPROVEMENT LOCATION: Address: :5f- Legal Description: Sec MV 1,6 Cd'TC_ Property Tax ID#: 3(1 17 QM7 Lot No. Site Plan Name: Ll Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: ' S; ,ebolt `VIL& Ao i-40y) &A a. tai CONSTRUCTION INFORMATION: a, Additional work toe e orme under this permit—check a appy: HVAC F]Gas Tank Gas Piping OGenerator Shutters Windows/Doors 11 Electric 0 Plumbing Sprinklers Roof Roof pitch Total Sq. Ft of Construction: SQ. Ft.of First Floor: Cost of Construction:$ Utilities: Sewer n Septic Building Height: OWNERAESSEE: CONTRACTOR: r r Name Name: Address: 37 5S ��jjd-Ar\ AUt_ ;:�&t IL 2-00 Company: {) City. `(ttM Lt�A= State:F1- Address: Zip Code: �5 A('}q Fax: City: State:21. Phone No. 7013 �1Z) -S/G�i Zip Code: Fax—+-:Q '7_ E-Mail: P f Ill 2J, c Phone N . Fill in fee simple Title Hol er on next page(if different E-Mail: from the Owner listed above) State or County License: C If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: �{ DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _X Not Applicable Name:—t%Ke-\- Name: Address: 6ffl&t, �& -%=4, '30-SrF. Address: City: State: City: State: Zip:33g3 —Phone: Zip: Phone: FEE SIMPLE T TLE HOLDS Not Applicable BONDING COMPANY: XNot Applicable '5WName: � . A LC_ Name: Address: 'V 200 Address: City: City: Zip: ,3.5fC Phone: "Va- - 1700 Zip: Phone: 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 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 yoo intend to obtain fipaming, consult with lender or an attorney before commencing work or reco In our Notice of mmencement. `! s Signature of Ow r essee/ ontr or sass A ent for caner S' nature of con"/License Holder STATE OF RI �' " / STATE OF FLORIDA COON OVy h COUNTY OF S+. LJ,&CAe, The f rgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of !��WJC I'\ 20 aby this_�3 day of 20 by (Name of person acknowledging) (Name of person acknowledging) (Signature Cootary Public-State of Florida) ' nature of Notary ublic-State of Florida) Personally Known _OR Produced Identification Personally Known >�OR Produced Identification Type of Identification Produced Type of Identification Produced ��� HE H►= HARDEN Commission No. :="..ar";ec SN LEY H. GUYT N mission N Com b.GG 25312 �. � 1,9y Commission Expires MY COMMISSION#FF171 98 Aucuo 28, 2020 ''F OFti EXPIRES May 13, 2018 Revised 07/15/2014 (407)39"153 FloridallotaryService.com REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS