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HomeMy WebLinkAboutBuilding Permit Application I CTt���QNSTA"'Ut C I ( A / tN flt M 1 `IC IeE �.... e: rl NamR/ENGINEER: _Not Applicable MORTGAGE COMPANY;'; I'I _Not Applicable Name: I. I Address: Address: i City: State: City: State. Zip: Phone Zip: �Phond: FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: i I i _Not Applicable Name: Name:. i. Address: Address: City: City: i Zip: Phone: Zip: Phone: OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated. 1'!certify that no work or installation has commenced prior to the issuance of a permit. �� j 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 restriction's which may apply. I 1I consideration of the granting of this requested permit, I do hereby agree that I will,in all respects,perform the work inl accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendrn'ents. Th,e 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! ses tolanother non-residential use I i 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 land posted on the jobsite before the first inspection If you intend to obtain financing, consult with j;lender"or an attorney before commencing work or recording-V60-t Notice of Commencement. % (Sign re of Owner/Lessee/Contract Agent for Owner Signature of Contractor/License Hdlder I !STATE OF FLORID STATE OF FLORIDA - COUNTY OF ,(„r�o. COUNTY OF II he forgoing instrument was acknowledged before me The forgoing instrument was?acknowledged before me this day of 20 by this day of ii 20_ by I�, I i(N of rson acknowledging) (Name of person acknowledging') j ' I Signature of Nota of=Flor-Ida=�'` (Signature of Notary Public-'State of Florida) aa•+P�•n,• LV:HAHNA INGRAM.. I I �"0. ° duc ".h'ir i fi-c of Florida OR Produced Identification �Personally Known Pr�daced identificatio .. Personally Known ,� !�ype of Identificati = •;My Comm.txpires�e�ep. Type of Identification I (Produced Commission# FF 177249 iI � goWed ugh National Notary ASSN, Produced I 'Commission No. " ' ' (Seal) Commission No. I, ! (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION I j SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW ! REVIEW REVIEW DATE j RECEIVED J I DATE ! J COMPLETED ev. 7/203.4 I � I ii, i All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / p / �1 Date: Permit Number: l lJ`` ��C7(O � j r o ,a Building Permit Application Planning-and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 i Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: PRtPQSEC} lI�P ©DEMENT LQCATO�V . �s - Q �. y Address: �3� ?tIFIC Legal Description: 16//J� & DR I W14-X !"���3 F�f_, F* PropertyTax ID#: �`7�����D'�a���` Lot No.H —3,-z)— Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: QE?AILD DESCRIPT1QN 9F WQRK x AO� Ae Z2 44CQISTRUCTION iNF0R11AT)CN y Additionalwork to be pertormed under 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: 1(� Sq. Ft. of First Floor: Cost of Construction: $Q 0C-) Utilities: _Sewer _Septic Buil.ding``Height: Q ( EtjLESSEE � CQNTRACTQR. .a . .°.*:.... - —B?.a. .>s _-. : ' _ ...ea .,... ` .,��-• `&c.,� . try Name h, N n"Rff y �/✓`, (� - ;;,'; rk. Name. Address: 36 7&JI ICAl -Mks QYaC- Company: City: P�S_-r State:EL Address: Zip Code: ? Fax: City: State: Phone No. 7i ���� 3 lz_�9 I 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.