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HomeMy WebLinkAboutBuilding Permit Application I All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: :_�'L!a II$ Permit Number: y p L 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: I ' .�& y*t fi.. +',,•}x'�# c" teals,«. i - 3a sr �, - w , I�e��ros��D ��U� uo�E ��� �a �Trl� ?d r �� ,� .�.a.. �. • Address: -'�O 3 -- 5 Pe,,,)4A c,,r4 LAj Legal Description: )&4&,,e_ geu-a,5�& cant 5,6,%4.d 51'7 4 I PropertyTaxlD#: Lot No. 9L Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: � 4,44• . P4Y <,�lC �/ l' �.1 t�� JG._1�r.L .5,,2:e I � J Additional work to be pertormed under this permit-check all that appy: _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:$ /��o�_rr1� Utilities: —Sewer —Septic Building Height: Name 13ruez- C Cdeeko;vPou Name: '�Zss.ae Address: Sro•3�5,, Company:'' A-iPok C-.<,,.e�<"__ dcL-,.- City: PSL - State:f� Address: V�6 A-;- ✓}A"do Ahi cl iZipCode: 3`I 9 g(. Fax: City: 196� <6uV Stater_ Phone No. Zip Code: 3V9�g 3 Fax: E-Mail: Phone No 77z-SrL,s- 5YZ! Fill in fee simple Title Holder on next page( if different E-Mail from the Owner listed above) State or County License Z5 3z.S�- I Ifivalue of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUIPPL= L CONSTR+IJCTI©N I I Lp►W INF©RMATi�'N: 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, Ido 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. Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OFA The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this AID—day of Yom, , 20AI by this J�J'_day of Yea,— 20AZ by e (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Public-State Florida) (Signature of Notary Public-State&f Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced �"""�� I 8C, 1' )iNA INGRAM Commission No `�,�� Commission No. ,��aYP" ( eal' �ASHAHNA RAM Notary Public-State of Florida o a, e ( � Notary Public-State Of Florida u °E My Carom.E>;piresDec 20, 018 W,2018 /t REVIEWS FRONT ZONING SUPERVISC!'R_4 PLANS VEGETATION SEATURTLE . "M'ANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.