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HomeMy WebLinkAboutBuilding Permit Application i ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: 1 Building Permit Application Planning and Development5ervices Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial J Residential v PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PRQPC�SEb YIPR©VMENT 3 s Rn K & x_sv._3._.,,.z £ i. g a 5ti�P1�� �l Address: //� ,,,, �-- ��S�. Legal Description: LAa-- Lum_ (�51A-MS PLk-F P9J 0A26 60T 3z COE 2-30 Xel)- - 124 Property Tax ID#: 3 if 24 0 3 — Q©L[& ` 000 1 Lot No. I ' Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side D `AILEC3 QESCt1PTIN DE WORK'' E t � ` ,,, ,,_„ ,2 ,.,�f��„-'�'-�sn�,z%.� „«-,,'= y„•„t°<. .,a.,. - _ �r � _ s, ,a g,�n�<- TSR . '�'� + �x a � I _CCIISTRUCTI� i�tF©RNATIaNq I y k ' -�«x Additional or to a etas Tank under this "Pr permit—c ec a appy: Gas Piping Shutters Windows/Doors Electric 0 Plumbing Sprinklers MGenerator Roof Roof pitch Total Sq. Ft of Construction: S . Ft.of First Floor: iirk ; Cost of Construction:$ 4 Go. cc Utilities: _Sewer Septic Building Height: CCIVTRA06 CTC7R E N a m e_U n©& U9V Name: (i tJA) RPA� Address: g agol S PcA)b P110 Company: �Wb A*D MOW 6)r-7W9 city: +'94' l 6(i State: Tom-- Address: g 37. S t W)b �fAqu* Zip Code: iM�')— Fax: City: 2 F,etc State: IT)No. CV ' a-qq" J�oL� Zip Code: )L u Fax: T?X aS��” 16033 E-Mail: Phone No. _7_7o? — 4t)tel' S—p 1 Fill in fee simple Title Holder on next page(if different E-Mail: n (w &a6'SafJ mre—tc. W/'Y\ from the Owner listed above) State or County License: C 2C. [33 1,5W If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. 1 f [/� (�5�'Y yh( (�� }.+3, }��(�n:Ay }� { } QI Lr1*1ENTLA_ . �.Q,N,8far 1 I1 �,#a�i ��} 1♦!Y(!'1�/, )i( h� r ? x � _ 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 AI mendments. 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 fender or an attorney before commencing work or recording our Notice of Commencement. A141c c Signature of Owner/Lessee/Contractor as Agent for Owner Signatur of ontractor/License older STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF I l.,,s�;�� The forgoing instrr4�ment was acknowledged before me The forgoing instru%�e``nt was acknowledged before me this L day of N6Y 20a by this day of I�1�� 20-P by Name of person making statement Name of person making statement Personally Known OR Produced Identification Personally Known I OR Produced Identification Type of Identification Type of Identification Pr uced Produced y� gna ure of Notary Public-Sta a of Florida) (Signature of Notary Public- tate of Florida) i Ac i,'ll!A I r HAM a' Commission No. %9,,, (Steal)' t� a I "'''� Commission No. ""' - s , 11r o, Notary Puhiic Slzli of Ronda QY Nota$edl��, 'Stat of Flo it my Comm.Expires L'ac 20,201 �._my Comm.Expires Der,20,20 Commission r FF 177259N ��; Commission # FF 1772?9 °` �• Bonded thio'i.gh National Notary AS.`n.h /%unn� Bonded th-ouati fNUoI;al NO REVIEWS FRONT yZOIVIIVG=='`SUPERVISOR ` ''PLANS VEGETATION., SEA�TURTLE-�``MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.8/2/17