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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: I O R E C =E'SLP F _ Building Permit Application AUG37 Planning and Development Services Building and Code Regulation Division PERMil FTING 2300 Virginia Avenue,FortPierceFL 34982 Si. Lucia County, F Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: 1 , PROPOSED I�NPR01/EMENT LOCATIO Address:_ ea C& Citnier Legal Description: PropertyTax ID#: Q 06' • Lot No. Site Plan Name: zed Block No. Project Name: y d.V Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK.: o �01NS�TRUC�TIN�11'11Wi'F©R4MA 110 Additional work to be pertormecl under this permit-c ec a tat appy: _Mechanical _.Gas Tank _Gas Piping _Shutters Windows/.Doors Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: 6366 Sq. Ft. of First Floor: Cost of Construction:$ Utilities: . —Sewer _Septic Building Height: ZS_' 01NNER��/77LE:SSE COT NRA OR: Name A QA16a 1,71 'Vo aAza Name: Address: /29 mar'"2&E !3w Company: . City: State: f/ Address: Zip Code: 33rV 7,41 Fax: City: State: Phone No. 77Z - r49 7--/JRW::5 Zip Code: Fax: E-Mail: aoA)G/ L,-Q r,21- 4-1ZM I 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. SUiPPLEMENTAL CO(�5l"R+UCTIQN LFEN LAW INFORMAI (ON: 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 work or recording our Notice of Commencement. Signal re of Owner/L ssee/Con as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDASTATE OF FLORIDA COUNTY OF l�ucl� COUNTY OF The forgoing instru ent was acknowledg-1 before me The forgoing instrument was acknowledged before me this day of 20�( by this day of 20_ by (Name of person acknowle ging) J (Name of person acknowledging) (Signature of o ary Public-State of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of IdentificaType of Identification tio Produced paroy'� KAREN S. NI ELSEN Commission Y r 1 , C'dsrWis n No. (Seal) Commission No. t My Commission Expires June 12, 2 18 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.