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HomeMy WebLinkAboutBuilding Permit Application i . All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: OU ) �., JU 40 - r 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: PROPOSED lN'PRt?VEMENT LOCATL(}. Address: MS Legal Description: Property Tax ID#: � � � t3 �2- 2- 60Oio Lot No. Site Plan Name: Block No: Project Name: Si tbacks Front Back: Right Side: Left Side: DETAILED DE�5CRI'PTION to, WORK. 17 fZ 6204- 429 0 7C adc 3e✓L 10 kLV CO N STRaU CT l0 I�N�FO R M ATI O N Additional wor 1-0beperformed uncier this permit-check all t at.app y: Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors Electric _Plumbing _Sprinklers _Generator _Roof Pitch Ti tal Sq. Ft of Construction Sq. Ft. of First Floor: r� U Cost of Construction: $ 2S Utilities: —Sewer- —Septic Building Height: 01NN�ER/LE=�SS� : CONTRAC*TQR• Name f/S /� i�d� Fi fig ��'� �SoC. Name: ke r t Address: J�2�/ �'1J C7 �o h lil ay Company: (City: LGK is 11 —State: Address: -?� � iZip Code: a — Fax: City: D`i'�a-o/ec,. State: Phone No. Zip Code: -3 YQ7 2 Fax: 3L 7 �E-Mail• r Phone No '9&3— e-l(,7 4-/73 3 Fill in fee simple Title Holder on next page(if different E-Mail C'✓"S i hfrom the Owner listed above) State or County License lt, :r J-4 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. I r _ SUPPI.EMENTA�CONSTR�UCTI©N LIEN LAW INFORMATIQN: 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 improveme to your property. A Notice of Commencement must be recorded and posted on the jobsite before the it t inspection. If you intend to obtain financing, consult with lender or an attorney before commenci g rk or recordingour Notice of Commencement. Signatur of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The ing instrument was acknowledged before me The forgoing instrument was acknowledged before me rgo this day of 20 M by this day of , 20_ by (Name of person acknowledging ) (Name of person acknowledging) a re of Notary Public- tate of Florida) \ (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced LASHAHNAINGRAM COmmISSIOn No. c`tPaY`ba( (Seal:)tic State of Florida Commission No. (Seal) Not My comm.Expires Dec 20,201 B *Qrrommisslon FF 177249 ••9%Foy `° Banded throu h P!aJonal Notary ssn REVIEWS FRO ,T <�,Z --SUPE O PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 7/2014