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HomeMy WebLinkAboutBuilding Permit Application / I F LLAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: i �eZ-_oings � i I I 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: I S Ver �Q_l rn V✓c�7 ii Legal Description: LIC C��� too►i — ���'C Z I LfJ f i, Cr�� 3gti I •-- 12-7z _)I Property Tax lD#: 9 H I H - '70 2-000'1 000- Lot No. �} ! � 1 Site Plan Name: Block No. _L-- � I ; Project Name: Setbacks Front Back: Right Side: Left Side:' I ;DETAILEDDESCRIPTION OF WORK: j �n51-1 11 II5 OF 6 , U"ny l �'��c� - 60 ` �'✓� �`�-' GJeS ie rn Pmfer� I r Ae -t- 3 3 I AV-O nc) f 6o l 6420► o� i�, c �sfi S i`�e. G I e� ;CU*- D0U0 C_ )D r,'JL Enc,4C fi� �e �'�tS ((e;� o✓rJ T1k2. west ,�,�rpt r. CONSTRUCTION INFORMATION: . Additional work toe performed under this permit-check a appy: HVAC 13 Gas Tank ❑Gas Piping _Shutters Windows/Doors L�Electric 0 Plumbing Sprinklers El Generator ] Roof Roof pitch Total Sq. Ft of Construction: P/3 Line. r 1' S . Ft.of First Floor`. i Cost of Construction:$ 21 SJ.On Utilities: _Sewer ElSeptic Building Height: OWNER/LESSEE: CONTRACTOR' �! Name it LG.,"S Ce ek^o n 1 Name: J6^ Address: S 1 S0ye-P cQy1 tJc�,/ Company: City: Q 'erre- State:2n_ Address: 36 tW (LIIt'v� 4�r�rr f7� Zip Code: 3 4 ci'-�F Fax: City: r�. P i fl Lr I State: P-4- Phone -4Phone No. - -63 ^ 8, 3- Q5$� �— © 0 Zip Code:� W�L((2• i , Fax: E-Mail - - Phone No. 7-2,-__ 32_1-75-2-6 Fill in fee si Title Holder on next page(if different E-Mail: f, rC­fV,?Cx CQ C, ,,1 co,--\- from CI,"`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 ' SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION lh . 'DESIGNER/ENGINEER: Not ApplicableMORTGAGE COMPANY: Not Applicable i Name: Name: ' Address: Address: City: State: City: State: Zip: Phone Zip: Phone: i.; ; 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 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#at may restrict or prohibit such structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply. i 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. 11 he following building permit applications are exempt from undergoing a full concurrency revie%ki;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 �commencing work or recording our Notice of Commencement. Signature of Owner/Lessee/Contractor as Agent for Owner Signa ure of Contra ctor/Licero�e Holder STATE OF•FLORID� STATE OF FLORIDA f ' COUNTY OF :l_,�_.�,� COUNTY OF The f rgoing instrument was acknowledged before me The forgoing instrument was'acknowledged before me this day of 3— .20 by this day of 20 GS by Name of person making statement Name of person making statement Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced i ko (Sign re f Notary Public-State%f Florida) (Signature of Notary Public'$ta of Florida) Commission No. _ ,�..-- (Sea);, (Seal) �� AHNA INGRAM mmission No. State of Florid Notary Pub' 20 B xpires Dec 20 + . COMM.m .7O ti nc NA INGMM :,gra •oma; Com ission ,°tafy g� i ti,Y'P�e�.; Pub! State Ot °r^1B s REVIEWS FRON o��, INisondedNS VEGETATI I�fr°> m. x[V1AN101� COUNT R VIEW REVIEW REVIEW N " a� ommis ionREVIE %4�5G� DATE o'F';.�``; Bonded thro °"°"" .._ . RECEIVED DATE COMPLETED Rev.8/2/17 i i