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HomeMy WebLinkAboutUntitled All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �� Date: Permit Number: 110!S C) 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 PERMIT APPLICATION FOR: PR©POSED INPRO EMENT LOCATI©N: Address: ` () La,V154--, .I� ss �. tai Z Legal Description: 1f d 54--, 54 1,v a e- PAIy . �S� ��y� C) Property Tax ID#: 3,/2Z vVi 6— co o- Lot No. Site Plan Name: Block No. Project Name: ✓G.. S��F.c��-r� Setbacks Front Back: Right Side: Left Side: DE A LEAD D �-SCRIP ON OF 1 f U(? /� '��• 7 C��°y P ��•ear G 6,14- X/_ c0// AAdd z�,,� CONST U ION INF(*O MA ION. itiona workto a per orme under this permit—c ec a that apply: K 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:$ ZSd a Utilities: —Sewer —Septic Building Height: / CONT KTOR• Name Tran 1L �r-XA , 'Wel Name: re lL u.1R Address:?0 & t Ar/' -Irl '*-whipany: t1ocr �0 City: r"4- 1plce-c e State:%L Address: 7DZ- Sr - n v�- Zip Code: Fax: City: 541mr r Stater Phone No. 77 2 '3 2i 3 Zip Code: I Vqq Fax: E-Mail: NLA Phone No 717--VI ) - _S Dq`7 Fill in fee simple Title Holder on next page(if different E-Mail !©Cra 14Vd QC o O wia' J• Ccs A1\ from the Owner listed above) State or County License e.4,6 7 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. UPPtEMENTAL C«ONSTRUCTION LIEN LAW INFt)RMATIQN: 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 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 you intend to obtain financing, consult with lender or an attorney before comm work or recordiA your Notice of Commencement. Signature of Owner/Lessee/Contractor as Agent 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 a day of 20La by this day of ,20_ by (N a of person acknowledging) (Name of person acknowledging) (§AnatVre o Notary Public-State o6FIorida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Poduce _ Produced .ISO �3 1 ommission No. Seal ommission No. "'^ "�Seb LA HAHNA INGRAM Notary Public,-State of Florida Comm Expires Dec 20,20.81 REVIEWS FRONT "41 C" V'IV1nI ommi3s� Wf§M PLANS VEGETATION SEA TURTLE MANGROVE "" A' Pdthrolghi. ryAss � COUNTER-1:.tI2EVaE _,REVIEW REVIEW REVIEW REVIEW t- DATE RECEIVED DATE COMPLETED ev. //2014