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HomeMy WebLinkAboutBuilding Permit Application i ALL APP�LICIAB+LEANFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED —1 Q Date: "I I "I� Permit Number: 30 f 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 VI-L [PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED fMPR®Uf'MENT L©CATI®N: �p Address: �1 IJTo v . Legal Description: I 17 Property Tax ID#: 51 1 1 S• L ® Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: 9 111,Y12-10:1115 D RENCORIPTION Of WORK: PIT , CONSTRUCTIO-N INFORMATION: Additional work to bp nertormed under tispermit--check all appy: HVAC Gas Tank []Gas Piping _Shutters Windows/Doors Electric ❑_Plumbing Sprinklers Generator Roof Roof pitch Total Sq. Ft of Construction: S . Ft.of First Floor: Cost of Construction:$ 1, I) U Utilities:cn Sewer E]Septic Building Height: OWNER/LE=-SSEE: C®NTRAGTOR: Name a11Name: Address: ) )� Company: City: S Stater .777. 771' Zip Code: Fax: City: State: Phone No.7 7�- Z25S—)q, Zip Code: Fax: E-Mail:CU 4 EN 11 Y) b � ibyl tb r(l Phone No. i 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. II SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATI®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: ASS q l� E)v Name: Address: all VA I Y 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 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 th first inspection. If yo intend to obtain financing, consult with lender or an attorney before comyn,enoln,g w r r recor i ur Notice of Commencement. Imsopil s n r own er/Cessee/Contract as Ageht for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this C1 day of 20 Eby this_day of 20 _by Sl-u k (Name of person ackno ledging) (Name of person acknowledging) Sign ture of Notary Public- ate of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification .Type of Identiffii ation Produced Type of Identification Produced commission No. (Seal) Commission No. (Seal) LASHA � Y{( �� Revised 07/15/fK. 1" 8� - Notary Public-State of Vtorida J° . My Comm.Expires Dec 20 2010 q A- :: N+ Commissio OF F��p rough t ar; a ary Assn.y REVIEWS F ';01�7,,11111"'LZEXNIN6_ S`U.kW VISOR PLANS VEGETATION SEA TURTLE MANGROVE COt�N"ER REVIEVI%���REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS