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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: _�� Permit Number:! l ®3' �- �- ' „ 3 Abu 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 Res,i.dential PERMIT APPLICATION FOR: PROPOSED$Ii "P°RO11EM1EIT LC.CAT<IN, k" Address: '7 0.17-RIt S P/ R9- Legal Description: ii I Property Tax ID#: ! CO /�`"U J '-© /"9 ' 1 Lot No. Site Plan Name: Block No. Project Name: li ! Setbacks Front Back: Right Side: Left Side: IJ AILED pESC�lPTIOI�l�QF�WORK: v z 6_Al CC5TtUCTION #� OR1IIATION �: �� ,_ :.. , r { Additionalwork to be performed un er t Is permit-check all,tbatzappy: _Mechanical _Gas Tank _Gas Piping Shutters' ; Windows/Doors El e tric Plumbing Sprinklers _-Generator _Roof Pitch Total6q. Ft of Construction: 9cU• F Sq. Ft. of First.Floo:r r's. Cost of Construction:$ �Z©� ° Utilities: _Sewer _Septic Building Height: 01� ERf LESEON..TRAGTOR71 .. .Name /V7-/Ak E `�� Name: i' � Address: TI�.S 12k— 13W-O Company: !City: Ike State:_� Address: Zip Code: Fax: City: State: Phone No. q9 7" I-Z P S� Zip Code: { i, Fax: .E-Mail: 16Ug4/ZL7400e- �TC.S VO- pn,eU4 Phone No f '. Fill in fee simple Title Holder on next page(if different E-Mail ! from the Owner listed above) State or County License i If value of construction is,2500 or more,a RECORDED Notice of Commencement is required. I'.. SUS �t�I�TR�CTI�}� � N �1N 1NC?RMATI��� 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. certify;hat 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 Code's 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 corrimpricing work or repording your Notice.of Commencement. Signature of Owner/Les ee/Contractor as Agent f - Signature of Contractor/License Holder STATE OF FLORID ,�!';i= STATE OF FLORIDA COUNTY OF "" ' COUNTY OF MI The forgoing instrument was acknowledge efor �Ae 8 The forgoing instrument was acknowledged before me this day'of m� �lyL ,20 4by �g Q this day of 20_ by ag= C � " INV M4r o .\ �1.1 (Name of person acknowledging) (Name of person acknowledging) a (Signature of tary Public-State of Flori a) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identificauv Type of Identification Produced - �. Produced r Commission,No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER :REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. /2014