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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: T 3—IS— ! Permit Number: Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce Ft 34982 Phone: (772) 462-1553 Fax: (772) 462-1678 Commercial Residential PERMIT APPLICATION FOR: PROPOSED INPROI/EMENT LOCATION: R ��' k Address: O :��c,,,+Luc I e f?U Legal Description: Property Tax ID #: { 3� 3� ` _ C I _ Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: I +FAILED ILE __D�ESCRIPTION _-/ Y.. _0RK : o r" �` 1-i r`� t r I �E it r�ac. �,e urs kms ONSTRUCTION INFORMATION: itiona wo- r<I to be performed u—fir this —permit— that apply. Mechanical Gas Tank _ Gas Piping _ Shutters Electric Total Sq. Ft of Construction: Cost of Construction: $3, Plumbing Sprinklers _ Generator Sq. Ft. of First Floor: — Utilities: Sewer _Septic OWNER/LESSEE: Name hi Ll'Cit C t VC: i Address: C� 3 a U -Ie 161 vel City: } I ef- Ce State: �L Zip Coder CI 5-1 Fax: Phone No.159u_ VA(p LD9G e E -Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) Windows/Doors Roof Pitch Building Height: Name:_(. Company: CCoI ,Iwo ill cy-AS �� fl{ 3 Address: CI o City: vrc�e- State: FL Zip Code: uCIS r Fax: -1 -)D -`W1 -539X Phone NdTla- 3M-OL4ci 1 E -Mail C_C` lalCad0—QODQli.C.Cfy--,_- State or County License CAC 19 1 C1 009 If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: _ DESIGN _ ER/ENGINEER: _ Not Applicable Name: MORTGAGE COMPANY: ^ Not Applicable Name: Address: Address: City: State: Zip: Phone City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: BONDING COMPANY: Not Applicable .Name: Address: City: Address: 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 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 rnmmnnrina %Ainrle nr rornrrlinv wmir NintirP of CnrnlrnPnrernent. Rev. 7/20114 Signature Contractor/kdede Holder Signature of Owner/ Lessek&oactor as Agent for Owner STATE OF FLORIDA COUNTY OF .. L0c STATE OF FLORIDA COUNTY OF S • The forgoing instrument was acknowledged before me thiss day of 20� by The for oing instrurpent was acknowledged before me this day of KA&-C�) 20_4 by (Name person acknowledging) (Name ofd rson acknowledging ) (Signature of Notary Public- State of Florida) (Signature of Nat ry Public- State of Florida j Personally Known OR 'Produced Identificatior)X Type of Identification Produced T --L. D � _ M —} �,NOTARY PU Commission No.r-1/ �� -+STATE OF F Conmm# FF95 Personally Known OR Produced Identification_,_,__ Type of Identific tion lY Stephanie Mou L � t NOTARYPUBStephanie r�roducedQQ LIC , C�1idnission No. F 7 f� © STATI= OF FL = Comm# FF9571 381 s�NCf IcJR,b Expires 2/412, .v �MAMMA' 0 REVIEWS FRONT COUNTER ZONING REVIEW SUPERVISOR REVIEW PLANS REVIEW VEGETATION REVIEW SEA TURTLE REVIEW MANGROVE REVIEW DATE RECEIVED DATE COMPLETED Rev. 7/20114