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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MYST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l p� Date: Permit Number: 11 ` 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: To Select from dropbox, click arrow at the,eind of line PROPOSED IMPROVEMENT LOCATION: ` n Address: 1e'9V2_o 6/etleS e.c +o-pF Legal Description: Property Tax ID #: Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: j eco. &o Lv n a SIC c S t-, vi e� b co PLe—n t o Xl y ra l J J Q oo t' g -vi r�Q e cz c N�� ta%c��l�i tx� ✓ BYO t1aIlc7tA CONSTROCTIONI-NFORMATION: ; I Additional work to be nertormed under this permit— check all that appy: HVAC _ Gas Tank Gas Piping _ Shutters N Windows/Doors Electric 0 Plumbing Sprinklers ElGenerator Roof Roof pitch Total Sq. Ft of Construction: S . Ft. of First Floor: ocv Cost of Construction: $ Utilities. Sewer OSeptic ( Building Height: OWNER/LESSEE: CONTRACTOR: Name Ste oat n Address: 41ft26 ,51;o,,L e IRcj _6Z q City: 0_0C0ci ft -S_ State:�L Zip Code:02. ;�(`%�% Fax: Name: ( b..2c-k-0'1 R to S Company: 6w1c-c. C. i o0 -c - Address: 8-7/ SW S��'l't. .lu0.c��v fel✓%• L City: ;Po -s --ii, S4. L cJ�iQ Stater Phone No. Zip Code: 3c(i 83 Fax: E -Mail: Phone No. 77a 02.6 7— s5 Fill in fee simple Title Holder on next page (if different E -Mail: _r���co��c�d �sp�.�t�C� y hov. c, from the Owner listed above) State or County License: 1130 3 If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: _ Not Applicable Name: Address: City: State: Zip: Phone MORTGAGE COMPANY:! _ Not Applicable Name: Address: d City: State: Zip: Phone':!! ,i FEE SIMPLE TITLE HO R: _ Not Applicable Name: Address: City: Zip: Phone: BONDING COI I : Name: Address: City:1-7 Zip: Phone: d Not Applicable Produced Produced ,i 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. it i 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 covenantslthat 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 ainother 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 vour Notice of Commencement. Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor cense Holder STATE OF FLORIDA STATE OF FLORIDA COUNTYOF 5r LilC1kz_ COUNTY OF 3T. LCJC( E - The forgoing instrument was acknowledged before me The forgoing instru en was, acknowledged before me this .Qday of G7 -D E I� , 20L7 by this%© day of G- 20 by Name of person making statement Name of person�naking statement Personally Known 0"_ OR Produced Identification Personally Known ✓ 'OR Produced Identification Type of Identification Type of Identification Produced Produced ,i (Signat rep Pu Irpp I"�� i (Signatu o#.i11 Publi "0 ` 'r°..`�; Notary Public - State o1�r��� Commi in ' • = Notary Public - State of i 6! Commiss• �� o • ' My Corn - u�-€acPrres Se 2 p 20 $ Aires Sep Commission # FF 12990NrFOFFI°P OF F� i, F` h Bonded ThrougNational Commission # FF 129900 Bonded iThrough National NotarAs }-sr; Notary REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED :I Rev. 8/2/17