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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: I• ` Permit Number: JULj 8 tCq, Building Permit Application PER!:1f17i;,;G SL Lucia I:oUntY, FL 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: RROPOSBD NPROVBM'fNT OCATION: Address: 4 "o Dig >&yKL` .l?iP Legal Description: _2:;/a1,o*✓ fla4F t HAS 3Cine//Yo(e-/se,,/,)/ Property Tax ID#: 3 Yod- 100g'oSf�-Doo "7 Lot No. /a Site Plan Name: rrjg�7 % �+e — IIn Block No. i'D7 Project Name: 101cI f'T7v�•' �-�l�f}l� c-i�UAx%� Setbacks Front Back: Right Side: Left Side: D ILE� DESS@RI 0 aF WO K. 500 TW /�iP,�f���•��' ��iPdyC /020�0�l�ar�iP,��c�L�iYc CONS UCTI®'N INFORMATION: Additional work to be pertormed uncler 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: $ Utilities: —Sewer —S eptic Building Height: OWN'M.3 M/1111 E47M CONTRA OR. Name -VAr -Y*-0A-i?!Y 641,1 /^1 Name: (A)M; Address: lOOO /Y V4 Company: City: � State: Address: Zip Code: c30*0 p map Fax: City: State: Phone No. -77A-67 6�-1660 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. SUPRLE ENTA C©NSTRUCTION LIEN LAW INFORMATION. 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 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 Commencementmay resulfln 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 obtainfi'nanbin& consult with lender•orrr a ,attorney before commencing work or recording our Notice of Commencement. ignature of Owner/Lessee/Contrac as Agent for Owner . Signature of Contractor/License Holder STATE OF FLORIDA _ STATE OF FLORIDA - COUNTY OFJG tiYYt- L.uG 2 COUNTY'OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this ISLth day of Ju 1 120 11 by this day of 20_ by k i ­7- C,r-*1 (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification Type of Identification Type of Identification Prod ucedFl(k trio l`rivef-, I <<��'ti`aQ Produced NICOLE O TADO NOTARY P fission No. (Seal). Commission No. FY I�SC7�3R (� ESTATE OF FL �'A Comm#FF 80038 Expires 12111201 ts REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION. SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW. REVIEW DATE RECEIVED DATE COMPLETED ev.