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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,s- _ Date: 6 � Permit Number: fou (93c(9 I . 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 Residentialy 1 ERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line - PROPOSED IMPROVEMENT LOCATION: Address: d Cl© baO -I)/-- >LIgaLegal l Description: I Property Tax ID#:�3 yD � d 6/ d , o��l 'OD(3 " � Lot No: Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION'OF WORK: CONSTRUCTION INFORMATION: Aciditional work to be performed -under this permit-c ec a appy: HVAC Gas Tank ❑Gas Piping Shutters a Windows/Doors Electric 0 Plumbing OSprinklers Generator Roof Roof pitch Total Sq. Ft of Construction: S Ft.of First Floor: f od Cost of Construction:$ -1000 Utilities: Sewer Septic Building Height: OWN ERAESSE,E: CONTRACTOR: Name �oSh �n � . �i}.��R Name: 6 1.4-ke5led_ oeGh,ie_ _Zie, Address: 62-35" AlW TA-ke- Company: nn City: Po,(� _S0� ,✓Ge, State: �r Address: /6joY JV44m4n RcJ Zip Code: 3 0f GS Fax: City: ezr e, State: Phone No. °f 2 77- 2-o�' �� y 5� Zip Code: ',-3qJY N Fax: E-Mail: Phone No. 22 ci9 Fill in fee simple Title Holder on next page(if different E-Mail: LLifvalue the Owner listed above) State or County License: L /3�D d 6 Z Z of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION'LIEN LAW INFORMATION: 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 commencingwork or recordingour Notice of Commencement. Signatu a of OppdfTLessee/Contractor as Agent for Owner Signa re o, Coy or/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF _T,CV Y COUNTY OF c��®v� �►q Qc- The forgoing-instrument was acknowledged before me Theforgoing instrument was acknowledged before me this`l — day of J r 20� by this`ll'' day of Ovr,,2 ?20t9 'by r f �` (G tl�itJ/r'� ( ✓4 �� � %fi r/P�r/s� Name of person making statement Name of person Waking statement Personally Known ✓ OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced JOSEPHINE 0.AFFLI K Notary,Public-State of F o a Commission#GG 042 2 -'_•« " pa:= My Comm.Expires Oct 26 2 20 ''FO Bonded through National Nota y sn. (Signature of Notary Public-StatLF1 JOSEPHINE 0. F� ' rYo a u of Nota Public-St - «�� Notary Public-.Sta a of Florida Commission No. �—� 2 3z Commission#G O� Qis on No. Com- 4a3�z (Seal) .� MY Comm.Expires ct 26,2020 ."• Bonded through Nation Notary Assn. REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE. COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17