Loading...
HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: ` W RECEIVED _ Building Permit Application MAY og 201$ Planning and Development Services Building and Code Regulation Division Perrnt. Lucting doftent 2300 Virginia Avenue,Fort Pierce FL 34982 Lucie County phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential ERMIT APPLICATION, FOR: PROPOSED 'NPROUEMENT L®CATION: :Address: /8 S S Si 0eSW Y Jf S -PA[ Lr' C E4 ( Legal Description: &)!AD V In '11 11i 8 Property Tax-ID#: Sly ' I.Or '0041' 000(P Lot No.� Site Plan Name: Block No. I Project Name: Setbacks Front Back: Right Side: Left Side: D TAILED QELS/CR+IPTION OF WORK: CO'N RUCTION INFORMATION: Additional work to be pertormed under this permit–check all that appy: 1 '_Mechanical _Gas Tank _Gas,'Piping _Shutters _Windows/Doors Electric _Plumbing _Sprinklers _Generator _Roof Pitch ~Total Sq. Ft of Construction: Sq. Ft.of First Floor: -Cost of Construction:$ Utilities: Sewer _Septic Building Height: ® NE RSM El COT CTOR: Name-&a-eW5, TJre 8 AJ,41 E Name::.,. -v Address:"/�yS� S, ��'E�?A��IQ. G v ''f CompanyoI 60q l0 s� i (City:, �%�i11.1110A) /�G'��°ly State: Address a F6 S 37 Zip Code: Fax: City: i<< . C° State:__f�L? ,Phone No.z"7a f73 /Lira Zip Code:{����— Fax: I E-Mail: Phone No 7;;� Fill in'fee simple Title Holder on next page(if different E-Mail� Q ����Q kld 0610,16 45 i A)kr- from the Owner listed above) State or County License ;2 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SU LEI •�NTAI.C©NSTRUCTt®N LIEN LAW IN'F®RMATlO1N: 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. Signati,o of Owner/Lessee/Contract as Agent for Owner Signatu of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA � J COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of �Q�, 20� by this day of Mo, 2012 by (Name of p rson acknowledging) (Name of pe on acknowledging) (Signa e af Notary Public-State Florida ) (Signature of Notary PublAo..State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification - _ .. T pe of Identification Produced 7 ;Arr"•, LASHAHNAINGRAM oduced z'4�'�� Notary Public-State of Florid fes' ( � m.Expires Dec20,2018 4ommissionNLASHI(,SealVGRAMCommission No. Commission #f FF 177249 otary Public-State o1 Florida Bonded through National Notary Ass . } ^° „ k°=N1Y Comm.E;.�ires Dec 20,2018 �;` ommission V rr I IIZ'IV r REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION';; :.SEA°TOP29' '` IVIiX1�Ga�tb�_�E COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 7/203.4