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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED `'� � (� Date: 1.1• `�• I Permit Number: ► t ® © �`�`' Q }1 r= FSS."!!4v !E 1)" Building Permit Application APR 11 209 Planning and Development Services PERMITTENG Building and Code Regulation Division St. Lucie County, FL 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: � �rl P,R�P®S'ED lN`P ®uE. .ENT.LQCt=A�1"10'N: Address: C �r1 �� tai(.S of fi pf e''ce- Legal Description: Property Tax ID#: © v ' Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: D � 'AILE'D DE�SC �I'P 10N 'aF WORD re 12 L csir VI c LL, Chi, tiz4j gad 41/7702, w,t6 New CO'NSTR'UC 10'N" INFO MATIO'N. Additional work to be performed under t is 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:$ I t r-0 Utilities: —Sewer _Septic Building Height: 011VR/LESSEE CONTRACTOR: Name Cr jjD b A- YO r j2 42 Name: Ce Address: E120 Cc l Company: -5_d1y are/ ecj ri LLC City: 1/e-(y j6pa c-1 State: Address: 2 (� , bLgr6ar PI-ide Zip Code: Fax: City: ve-('d 9 eq c,4 State:-f—Z- Phone No. 9q D , P� Zip Code: 3 7 y Fax: E-Mail: Phone No 7 7 Z— 55-6 q:- 0 f Fill in fee simple Title Holder on next page (if different E-Mail L Ot OG• Go�J' from the Owner listed above) State or County License b C- f 3 06 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. �PLSME 1`AL CONST r'tJCTlON LIEN I:AW INI"®Ril1/Il�T1®'N• 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. r Signature df Owner/Lessee/Contractor as Agent for Owner Signatur Contractor/License Holder STATE OF FLORIDAo, . STATE OF FLORIDA COUNTY OF I_t�C�( COUNTY OF The forgoing instr ment was acknowl edg before me The forgoing instr ment Ws acknowledge efore me this day of lr 20 by this day of I 20 by v r (Name of perso iiacknowledging) (Name of perso acknowledging) 'it 6 AA (Signature of-Notary Public-Slate of Florida) (Signature of Notary Public-State of Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identification ✓ Type of Idenqirytio ntifi tion b�: ; Par.�e KAREN S. NIE�wce Produced �° �2EN _ - Commission R Ff 115637 ac; =y o� My Commission Expires, Commi S. NIELSEN Commission No. . „ dfl June 1 2, 20��$mmis i n No. p. My�o g�al1 FF 715637 — " mission Expires JU 12, 2018 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION li SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. //21014 if I