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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 Date: 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 Residential PERMIT APPLICATION FOR: PROPOSEUJINPROVEMENT LOCATION �"'r ''` a '� r .:. } Address: 1 Ll b Legal Description: Property Tax ID#: ) 000 - ooc� Lot No. Site Plan Name: Block No. Project Name: ' Setbacks Front Back: Right Side: Left Side: QE7'AII.ED DESCRIPTION OF WORK z rrd V 'MIRS" i� „ '*' Yrs Clh,? 1-r te— - GONSTRULTION INFORMATION r 2NN 7,g aW . A881tional work to be pertormed under this 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: $ J�y 0 D Utilities: —Sewer _Septic Building Height: 01NNER LESSEE' CON`fRAG1"OR NameName: , S..' Address:.._ 10 , S. 1:1 0 Company: © City: U� State: Addres1_ Zip Code: a�I Fax: City: OOyr�I�r` ' &C,K 1 State: Phone No. ' 2D Zip Code: 13 Fax: S- E-Mail: Phone No Fill in fee simple Title Holder on next page ( if different E-Mail GJ 72 QSy4 L - ✓11 from the Owner listed above) State or County License xr)- If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. LR', ,f�1/t11� `aCONSTRUCTION NJ I.AW INFORMATION :.::._. i ... .::... _ 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 in 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. t &(,'A 7 Signature of Owner/Lessee/Contr ctor as Agent for Owner Signature of Contractor/License Holder STATE F FLCOUNTOYOFORIDA�5T 61c,-'L— OUNTSTATE OYOFOR Si L,vc�� The fo om ing instr ent was acknowledged before me The for oing instrument was acknowledged before me this Ul day of 204 by this bi day of MAY 120 by Ly (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Public-State of Florida) (Signature Notary Pub ic-State of Florida ) Personally Known �_OR Produced Identification Personally Known OR Produced I Type of Iden ' ' Type of Identifi a �c� SOPHIA HARRIS Produced s'`!"p�" :: 3®PHIA. HARRIS Produced = , �� #FF997093 MV �: • , FF997093 3p Eh''•.t.a w,4 30,2020 Commission 6�:�+. Ent-ikl'MAY l,'e2a9�0 Commission No. . ?q ` ,�allo�ryS (401)398-0153 FbrMallotarySerMCCom REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.