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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q Date: Permit Number: enct _ _ 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: Address: 30L 191 L-104C ld k'•e IJ 112 Legal Description: Property Tax ID#: O(s (. .Q'5 00 Lot No. Site Plan Name: Block No. Project Name: S�etbacks Front Back: Right Side: Left Side: e— Additional work to be performed under this permit–check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors Electric _Plumbing _Sprinklers _Generator _Roof Pitch T10 tal Sq. Ft of Construction:. Sq. Ft.of First Floor: Cost of Construction:$ oZ Utilities: —Sewer _Septic Building Height: Name J-1I i t3 f' ,/viler rr� Name: A4-z,i,,, 404.-Ar Address: 'T.35 old 44 Qlac 4-- Company:A e/4MS Ie•?cam a2 LLC City: (,/ Cr6 6e-'zLC-4 State:j!5�— Address: IQ o Y5 Zip Code: 3v2d �0 0 Fax: 9? X95='20,31 city: 11cr6 4�r"'-4 State: Phone No.9r) 3- 9– 03 d' Zip Code: 3a4 2 Fax: 99d--955-a03� E-Mail:Q961 i1S�f/y'c e–r262�/�tcc)'"" Phone No 99a -999 P-©3 Fill in fee simple Title Holder on next page(if different E-Mail �S t'nce �Y��<�- from the Owner listed above) State or County License 01?y If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. 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 recording our Notice of Commencement. Signa "e of Owner/Lessee/Contractor as Agent for Owner Signature6f-Contractor/License Holder STATE OF FLORIDA \ STATE OF FLORIDA COUNTY OF COUNTY OF �V`9s g The forgoing instr ent was acknowledged before me The forgoing instwment was acknowledged before me this day of 20_ by this day of 201:3 by (Name of persona nowledging) (Name of person knowledging). nc 4. 1i ature o Notary Publi State of Florida) Qhil ure of Notary Public-'St-hp_ of Florida) Personally Known- OR Produced Identification Personally Known OR Produced Identification Type of Identification. Type of Identific t_io� Produced Produced 4''RyP'!" LAS ANniq,INGRAM LASN=INGRAM =g+ .#� Notary Public-State of Florida Commission No. °. ;`�; Notary Pubida Commission No 2 •" *'S My Comm.Expir(Seaj)20,2018 _•„ My Comm.Expires Dec 20,2016 9,FOFF`0��.• Commission#A FF 177299 Commission e,FF 177249 '"'���"'� Bonded through National Not Assn. Banded through Nation woiary Hbbli. REVIEWSF ZONI SUPERVISOR PLANS VEGETATION W SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.