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HomeMy WebLinkAboutBuilding Permit Application i All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: -�3- /Y� 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: i :" :: i , dt i IS y, wJ�i 41� r�. .rtni�1 �-"S•4. PRQPOSED INFROVEMENT LOCATIQN 3 Address: �O,XI_ r /=0 722-e-:CG^ Legal Description: co- Anod w-&O-kr Lint -t-o Cc� Property Tax ID#: �J% ��(SQ (� (� ' -3 Lot No. Site Plan Name: Block No. Project Name: t Setbacks Front Back: Right Side: Left Side: 1- MEW- DETAILED DESCRIPTION QF WORK +� 'rsm I I I . I YNj CONSTRIJCTIC)N INFORMATION 4 Additional work to be performed under this permit-check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors Electric '-�umbing _Sprinklers _Generator _ Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: I Cost of Construction: $ Utilities: —Sewer —Septic Building Height: 011VNER/LESSEEt,;tnY � . ._.... : .. �' i�:. i.?� =Fir Ji:`�" CONl'RACTOR� '� Name_ - hI. I Name: Ad,dre �c I'�� i�� �' - �' E Company('�A / Ci "� C cc�C _. State:�� Address: Zip Code: Fax: City: ���� State: ,•- Phone No Zip Code: 7i �/� '� Fax: I t E-Mail: - _ Phone No Fill in fee simple Title Holder on next page (if different E-Mail A from the Owner listed above) State or County License E__ 3 r If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. Y SI �P , Mtk[,��ONSTRU�TION' LIEN LAW INFORMATION ! 4 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 l 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 Comme cement ma result in your paying twice for improvem s to yo-r property. A Notice of Commencement ust be recorde and posted on the jobsite before the first inspectid. If you intend to obtain financing, con ult with lender r an attorney before commenc' work or recor in our Notice of Commencement. Signature of Owner/ e/Contractor as Agent for Owner Signature of Contractor/Li se Holder STATE OF FLORID I STATE OF FLORID L COUNTY C Lu�(� COUNTY OF U t�,e — The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this 2;1�day of Ul 20A:� by thisday of t 120 by ,3L C' (�s 4_0L(:r' 1J rS- �P a- (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary-Public-State of Florida} (Signature of Notary Public-State of Florida) Personally Known_X,OR Produced Identification Personally Known OR Produced Identification Type of Type of I Produce `'""•` '': SOPHIA HARRIS Produced SOPHIA HARRIS =' MY COMMISSION#FF997093 MY COMMISSION#FF997093 Commis io `'' EXPIRES May 30,20�ea1) Commissi �+�; y ;Ir EXPIRES May 30,40J6ea1) (407)398-0153 FlaidallotarySerwce.c= (46t)UO-0453 FWW mOterySm"com REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE '} COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED-`"'r ev. I ST.LUCIE COUNTY UTILITIES-P.O.BOX 728,FT.PIERCE,FL134982^ I SEWhk--7 RES NAME Lali anKA METER SZ,, M/F / L4 f �! 411 ?5s , V ACCT.# / IRR C -pall ! $ �-� SECURITY DEP SERVICE ADDRESS ✓� D it SERVICE FEE SAME DAY FEE SUBDIVISION I. LOT 6�C)— BLOCK OVERTIME FEE C� BILLING ADDRESS �Y YCr v1 e In, l��! METER INSTALL.' I > >7 � CFC/WATER �( (�P�Cc F G L(q FPUA CFC LOVEA ( PHONE# oC IN/CLOSING DATE -2�_ 71— L _CFC/SEWER This application hereby request and authorises the Utility to render water and/or sewage disposal GUAR.REV. services to,the premises described above in accordance with the Utilities present or future rates, LATERAL rules and regulations,which by reference are made a part of this contract.Applicant agrees to pay _ the Utility promptly for such services in accordance with the established rules, and regulations. $ ` , C TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE. ' CUSTOMER SOCIAL SEC/ SIGNATURE FED]D NAME OF SPOUSE SPOUSE SOCIAL SEC. I !I I OFFICE USE ONLY DATE RECEIVED,5V CASH— CHK# _ RECEIVED BYL!�LL� i � i This information is believed to be correct at this time but it is subject to char a and is not warranted. ©Copyright 2017 Saint Lucie County Property Appraiser.All rights reserved. ; i I i I � I ! I i i i I i