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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 7 Permit Number: 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 Residentialy' PERMIT APPLICATION FOR: To Select from dropbox,:click arrow at the end of line PROPOSED IMPROVEMENT LOCATION: Address: (o)D leo Yle) -0/. F -34TS) Legal Description: � o�1� \ '�� ��h S��- ��-za�ra� ` - L o 31,0 (44-top f 3�/2$ ©r- Property Tax ID#: C ?.1"2- S © (DO 3 Lot No. Site Plan Name: Block No. Project Name: r `.,a yA ., e-y- Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: S'—A u,/-,-S- c� cone. ✓'S� CONSTRUCTION INFORMATION: Additional work toe performed under this.permit-check all tha appy: HVAC Gas Tank ❑Gas Piping Shutters Q Windows/Doors Electric 0 Plumbing 7Sprinklers FI Generator Roof Roof pitch Total Sq. Ft of Construction: S Ft, of First Floor: Cost of Construction:$ �, 6�� . g� Utilities:ll Sewer 11Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name Name: Y-1 OtVh 7-a e Address: 10 i 0f Or Company: Q .T. A'\rr-i cone City: - Al,era- State: F�_ Address: ('00 Al 4t' Y lffw� Zip Code: Fax: City: e-,-c9- State: 9��-- Phone No. 771-52J r 97671 Zip Code: 34q-S-I Fax: 772- 7 4y-IS9'D E-Mail: Phone No. -77-2 -^7-3`i - 15 Fill in fee simple Title Holder on next page(if different E-Mail: from the Owner listed above) State or County License: If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. i SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: 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: 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. n &117 s Sig atureo wner/Lessee/Contractor as Agent for Owner Sig ature o Contractor/License Holder STATE OF FLORID STATE OF FLORIDA COUNTY OFA COUNTY OF S�-+ sZ , The forgoing instr ent wa cknowledged before me The forgoing instr ment was acknowledged before me this day of 20 �by this day of 20 11 by 1 i (Nam o erson acknowledging) (Name f person acknowledging (Si atur of Notary Public-Stat o Florida _154naiture of Notary Public-Sta f Florida) Personally Known= OR Produced Identification Personally Known OR Produced Identification Type of Identification Prig e , Type of Identification Produced ,,,.t ..;,,, LA51AHNA INGRAM ommission No. Commission No. a` N�SE)ublic-State of Florida ,.�Pa�P�, I LASHAHNA INGRAM + r° My Comm.Expires Dec 20,201 e + Notary Public-State of Florid o�F��.� c'+ o•= y Comm.Expires Dec 20,2018. Bonded through National Notary Assn. �=;9 "a:� Commission #, FF 177249 Revised 07/15/201. •,', �„;,' 1 Bonded through National Notary Assn.t REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE .COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS