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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 7� Date: Permit Number: ) , s COL!.NY F L © R I CO A 1.-1111114.4111.111111.1.1 Building Permit Application -Pe to Planning and Development Services °S,.fr'�`,�'6 Building and Code Regulation Division t O 2300 Virginia Avenue,Fort Pierce FL 34982 t 40;:a !B Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential 007,% *e,... 0,,e, PERMIT APPLICATION FOR: PROP:(3S�E'DEIN'IpR'O�UEMENT LO�CA13,0No 1� f tl '' Address: /(7/& l�l /& / Legal Description: __ - _ f _ id -20 Z_ �' I ' it) 2-- 'Iii i '` _la Property Tax ID#: ?j y0if-'"` ' / - /12 57 7 - rcO P Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: - - D.�ITA.6l.ED D,,E?SCR,IPTION ©[WORK° ,c-A7•e--. - Z/LG[A ) C,‘ ) t_ — 1.s+-z;-2S2 !tefft (_ ii,.(7_---, - -- ----- ,�.. .. q ,�+�gw ;,.gyp ' ia--.,%...i!: ,� 'o,,,:... CONSTRUCTION IN�PORMATIONo ., - ,, Additional work to be performed under this permit-check all that apply: _Mechanical _Gas Tank _Gas Piping _Shutters 9Windows/Doors Electric —Plumbing _Sprinklers Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: f 0p Cost of Construction:$ / -/ �Ov Utilities: _Sewer _Septic Building Height: OWNER/LE�S�S 1E° '.' ' t CONTRACTOR: . Name 1 ' !1 .� �Id`ii(,a Name �.., .,, Addre . L'1 /R_,S 11'LJ ::,..Company , • .. .4 is City: r I Stater Address: Si Zip Code: FZ Fax: City:, _ State:1 t✓. Phone No. Zip Code: 2- 62 Fax: E-Mail: PhoneNo 7 : 1 :7l Fill in fee simple Title Holder on next page( if different E-Mail,,. _ ,,� , /_ ,/ T-4=TOM from the Owner listed.above). State or ount- Licensee 02p-it- 2r7 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. 40°'PLEMENTAL @ONSTRU'CTION'LIEN'L► 1NF+ORMATIONo ' DESIGNER/ENGINEER: Not Applicable MORTGAGE_ . M _ E COMPANY: Not Applicable Name: Name: Address: Address: , City: / /. i� A ) State: City: -7t- State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable Name: Name: Address: Address: /G. City: ) City: '(/ Zip: Phone: W, ' 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, cons wit lender or an attorney before commencing work or recording your Noti e of Commencement. f ry '962,c 6-(71( ,V Yi i / ;,s it / Signature of Owner/L ssee/Contractor as Agent for Owner Signa u er"o- ac or/ ' ense Hold: Jj STATE OF FLORID STATE OF FLORID / COUNTY OF 1\"t A 2-A Jl(-(2 COUNTY OF `-LL-1 --e---(211--- The forgoing instrument was acknowledged before me The forgoing instru ent was acknowledged before me this IO•hday of N yi-y ,20.0 by this 1k-c day of ,20 (Kby n aiiV4C"t ff �Jr611 -. am S S c ', ,•.\--•� � N ;t (Name of person'acknowledging) (Name of person acknowledging) ignature otay r�f�b ic-State of Florida) gn ture of Notary Public-S to of Florida ) Personally nown ,/ _ ... - ---_ Personally Known OR Produced Identification f°'' 1.ANDYKAYSMM:1- Type of Identification Type of Identification *_ MYCOMMISSION#GG 142143 Produced "' Produced '4a7.,A: •IRES:July 15,201 ,-,.....t.,,11.•.,_-.1 - - •TOFF;°••• Bonded Thu Notary Public Underoniters �,,,i�,„, I C.—___ Commission No. Commission No. ,°,,,Pr 1°a,•, Se2Iiit�`�►NGRA � co ziJota$Pr�bli -State of Florida , y-°n My Comm. E::pires Dec 20,2018+ `I t,4 F, I;,p`s: o.GGiulisb ul1 r`-i't' 11/299 V Sande rouol PI=F,,�,��� •, REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION- SEA=TURTL-T-�IVIANG'."O E"• ' COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED iev. 7/2014