Loading...
HomeMy WebLinkAboutCameron Door Permit App 2017ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 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: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION: Address: 9? CO ) (DYAP- Pc)ff 9I6cC (f, Legal Description: PnQ 33 Ae-sey4 , !" I e4_,s, 1 0t i5 Property Tax ID #: 333 Ll ` 500' - 00 93 -006-9 Lot No. Site Plan Name:tt�� Block No. Project Name: C.Gt m @C`C)tl Af'5, Setbacks Front - Back: - Right Side: - Left Side: DETAILED DESCRIPTION OF WORK: CoA(Aa � [c�ct i c�GC` ` �I�t r (Jew (c , 1,4v G)t(J�er, t`©M 660�- CONSTRUC7ION INFORMATION Additional work toa performed under !his permit -check a appy: j�j C%h 1 HVAC l _J Gas Tank Gas Piping _ Shutters �indows%Xoo ❑ Electric ❑ Plumbing Sprinklers FIGenerator Roof Roof pitch Total Sq. Ft of Construction: SFt. of First Floor: Cost of Construction: $ Utilities:cnSewer Septic: Building Height: OWNERAESSEE: CONTRACTOR: Nam �T -0, chi ," ¢ Name: `!� s I�C��c�I I r �_C�l� Company: A ('c) il (N ca Address: Cc Address: V/ II C14,,e' L -C q ✓) City:C_D[ti n fr 01 'At) -1 f` 6 R State: 13L Zip Code: 3 00 % W O Fax: City: Y Stater Phone No./ `> 7� l �- f `� j Zip Code: 3±j S" _S Fax: E -Mail: Phone No.�Z-Z /- 57-36 3 E -Mail: Cl, I (c i%, I ji2de ltCc . C.Or Fill in fee simple Title Holder on next page ( if different from the Owner listed above) _ State or County License: CAC(- c J If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. fi' f VI : I1� i S1) LICTION LI. ,W 111 i /IATIO'N . DESIGNER/ENGINEER: Name: see � c� _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Address: �sa Address: City: Zip: Phone State: City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: Name: Not Applicable BONDING COMPANY: Not Applicable Name: Address: Name of person making statement q Address: City: Type of Identification City: Zip: Phone: Produced 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 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 commencine work or recordine vour Notice of Commencement. Rev. 8/2/17 Signature of Contractor/License Holder Signature of Owner/ Lessee/Contractor as Agent for Owner STATE OF FLORIDA STATE OF FLORID -111 COUNTY OF 51,k JC (G COUNTY OF , The forgoing instrument was acknowledged before me t`dayof Th r ng instrun ent was a nowledge�d- before me this /li°tJtitjwyI-Jtf 20j�-by thi ay of ,20 r roy Name of person making statement Name of person making statement q Personally Known �� OR Produced Identification Personally Known OR Produced IdentificaAn Type of Identification Type of Identifica kan Produced _ Produced �' CTUPAb AU ' S AVOCATE Si nature of N VEY ( g ar 1,(, ,, Stat of F'1k9fi�hE } I N tary Public - State of Florida (Sign ature-ofNotary Publi ate loricl,�) Commission No. =A"Cl lj cJ1H4J9 Commission No. =N: Commission( eC )010707 25, 2020 �C =,qr� � r , y Comm. Expires Aug Bonded through National Notary Assn. REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17