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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I ' 1 Date:_ �� Permit Number: t S70 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 PROI?OS00,'_ RCIUENIENT LOCATION Address: Legal Description: 3C 920 Al Z.- v1W SC 1 Of IVS- ! 33 r4- -fir RD 41W - (y75,4c� ('nr VVf5- 22'9G Property Tax ID#: Zile Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DE5CRIPTIQN OF WORJ{': 14 G Sys{p 7 Z.5~Tvri1// 060o c(m'?'n "44Hw rr ':T'sVf" ('�n�eYLSPit' Wr"�. �JC4t1 EjCC.�r'i�. Lt�a'�rr CONS 'RLICTIOIU INFORMATION AdclitionalworktobeDerformed under this permit—c ec c all that apply: �IHVAC Gas Tank ❑Gas Piping _Shutters F ]Windows/Doors Electric F�Plumbing Sprinklers FIGenerator Roof Roof pitch Total Sq. Ft of Construction:-- /2100 S . Ft.of First Floor: Cost of Construction:$ O&, Utilities: SeweE Septic Building Height: QWNER/LESSEE CONTRACTOR ._ Name To Le (V Name: 7,a va Iry tiioli-m Address: d Company: 0y Ku Gh City: Peri `tS� LNGiL State: �G- Address: F© ,D0X_277of Zip Code: Fax: City: PV-_ --LAX& State: E�_ Phone No. `l�1 �2$ �35 Zip Code: N1 Fax: E-Mail: Phone No. q 5'Y 6�� 1..5 T Fill in fee simple Title Holder on next page{if different E-Mail: t✓!Ke_[ eV j@ CAU CrAvetify. com from the Owner listed above) State or County License: CAt 191 7( /5r 1f value of construction is$2500 or more,a RECORDED Notice of Commencement is required. i SUE?PLEMENTAI CONSTRUCTIQN°LIEN LAW INFORMATION 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 commencing work or reqding your Notice of Commencement. (��Zzv" 1 6-110 S' ature of Owner/Lessee/Contractor as Agent for Owner Sig ure of Contractor/Llcense Holder STATE OF FLORIDA .-. STATE OF FLORIDA COUNTY OF S ( L v C-{ COUNTY OF S 7 CIC— The fo�rg¢ing instrument rxuas acknowledged before me The for oing instrument w s acknowledged before me this S't� ay of !�DS`" I 20 by this way of of— &6' ,20 by R &,f CY _lQL�',a Cl eyC'{G.. Name of person making statement Y ame of person making statement Personal) Known OR Produced Identification L D L- Personal) Known OR Produced Identification Type of Ident' ication Type of Identification Produced_ l- 9200 —Zt11(-At t—-7�- :> Produced FLdU J12' QQ—G.2b --ffcM 77—w (Signature of Notary Publi at&q&FIorida)THEODORE SARANTOS (Si nature of Notary Publi -S `.CPRY atiu�t,,, Public-State of FI rida Y P °�Pa u���,, THEODORE SARAN Commission No.N 3 1. _ ;•_(�� r'=t ;�`Sok ry Pablic-State of F! ida Co mission# GG 0447 �o misslon.No- 'o,9FovF�o��` My Comm.Expires Nov 3, 020 "-�' ' Commission#GG 0 4 3 ". `e. 020 MY Comm.Expires Nov 3, PIZ REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED J_ DATE COMPLETED Rev.8/2/17