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HomeMy WebLinkAboutBuilding Permit Application 1 , All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 'Q 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 _ I PERMIT APPLICATION FOR: a I R PC7tSE61� RO�IENIC T LO:CA�IC N g ,,,..,x..n@e� E � 3a�Ri Address: Pr ' Legal Desi r'ption: . Li&c PropertyTax ID#: 3 C2,= [� �C7� --bcC� ® Lot No.Site Plan Name: Block No. 367�' Project Name: Setbacks Front Back: -Right Side: Left Side: DAILE© DESCRIPTION OI*WQRK� i- l^rI ( L e m✓f- -3 S70 1 o -4) l !tyC�- agc) t �ttfP4aa f T-4411 /S1Sf'19-14- CONSTRUCTION IN1=0RIV�ATION s� Additional work to be performe d under this permit-check all tat appy: K Mechanical -Gas Tank _'Gas Piping Shutters - _Windows/Doors Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: z Sq. Ft. of First Floor: Cost of Construction:$ 3 fr9D Utilities: _Sewer _Septic Building Height: Name..n!10 rd"I J3 (� 0A Name: t�s�_r.d/� L.),4 -Fe , r ;Address:- q ll/C +(,S 8,1y Company: 09-w-e ;City: ��crvS� Vic_ State: IlAddress: SicDl Fax: City": �ar� ``Pim State: Phone No. �^ Zip Code:;^� ��/ Fax: E-Mail: Phone No. 70—( / 6 Fill in fee simple Title Holder on next page(if different E-Mail & GAJ CjC,`t-e -s/0— "Lx , ryL,- from the Owner listed above) State or County License CZAC j Do If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUP�k.EMENTA�.C�NSTR.UCTIQN LIEN LA1l�f 1��}RNIATIQN.� � � �� EF &" � ��, 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. 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 commencin work or recording our Notice of Commencement. ignature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF SkLt,,r,� The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this 2�Z day ofONQat),_ 20A by this Daday of fY�w�c4.�, 20 a by (N� -person acknowledging) (Name ofperson acknowledging) i (Signature of Notary Public tate of Florida) (Signature of Notary Public-StJ0 of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced_>�=i� Wig, , L`.SHAHNA INGRAM Commission No. (Seal) Commission No. ` ,' '== 8� rlotary�Seal;)-state of Florida '-- My Comm.Expires Dec 20,2018 A° nqRt0.INGRAM ,�=,,n.� ° r ommissian #FF 177249 ,2�y�o,, \otajy public-state O rI1 j yO Bondedfhroug National Notary san. REVIEWS - _ N q„ron.rrZO,NING RVISOR PLANS VEGETATIO'N.,> SEA TURTL v `IVIA R V Rco rrilkEVI,EWF 177. 4 s IEW REVIEW REVIEW REVIEW REVIEW LEKev. E Bonded PUT, •o;; _ u; EIVED `. E PLETED