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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �1 q Date: 5 a� Permit Number: RECEIVED MAY w 6 ZOa7 r, 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�P®SE© IN+P ®1/EMENT LOCATION: Address: V"Oa Legal Description: PropertyTax ID#: a.IV3y- 333 moo)-C ocj-'A Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED hiill CIF WORK: Hea n a ro ` dl 1 g e avl rc�n� o v, A �6A, f)rl S 1 1-Irl r Y C oyi Ir, h - s(Je' CONSTRUCTION NFORMATION: Additional work to be per orme un er 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: $ asp'.00 Utilities: —Sewer _Septic Building Height: OWNER/LE1SSEE CONTRA OR: Name '' Name: nn Address: WU (A) , 11�PO��r�C�P le Company: City: &Crc-e— State:16, Address: Zip Code: 1 Fax: City: State: Phone No. _]R�-o`2�IQ � � 7`S Zip Code: . Fax: E-Mail: Phone No 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. SUPPL jWI@NMATION 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 commencing r gLxzcQrding your Notice of Commencement. Signature of Owner/Lesse C tractor as Agent for Owner Signature of Contractor/License Holder STA E OF FLOLRIDA STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this3 day of VIN Qi 20� by this day of 20_ by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary PubW-State of Florida ) (Signature of Notary Public-State of Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identif'cation Type of Identification Produced Produced Commission No.Ef 41S41 Co (Seal) Commission No. (Seal) pMsAMAR1EQNENS MY COM AISSION#GG 022023 REVIEWS FRON '-* o, IN@XPIRE :9 R%56R PLANS VEGETATION SEA TURTLE MANGROVE COUNT ":;; ; �/IFedThn Notaa��p eiwrte EVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.