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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: U Permit Number: RECEIVE Building Permit Applicatio JUN 5 T1s Planning and Development Services Building and Code Regulation Division STT.. Lucie County, Permitting 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential — PERMIT APPLICATION FOR: Q PMR. PtJSED INPRO EMENT:LOCATI®N: , Address: 119 ©ui'Gt7 S'&. eneo C� Legal Description: Q K!et nS •Ce r Lt,n ;� J- Property Tax ID#: Lot No._H Site Plan Name: Block No. 41�5 ProjectName: Setbacks Front Back: Right Side: Left Side: i DETAILED DE�SCRaI"PTI®N O Vt/OR�K: C C®NSTR�l1CTf,0N (iN:f=ORMATION: Additional work to be performed under this permit-c ec all that appy: _Mechanical _Gas Tank - _•Gas.Biping Shutters. _Windows/.Doo'rs _Electric _Plumbing ;(sprinklers _Generator _Roof Total Sq. Ft of Construction: / Sq: Ft.of First-Floor: Cost of Construction: $ -Its� Utilities: _Sewer _Septic Building Height: p1 ®WN.ER/LESSEE• C®.N�RA�ITI Name Name: - - O L Address: Company:e-a .1 ..- rS City:'�'L IF'r. e;'Iemt­. State: F11 Address: 3�. S uti'� r Zip Cod'e:-jo-?/q f "Fax:-.^ !✓A City rr-• i:e--iI State: �L Phone No.,52�/—Y 7 6J-5— Zip Code: Fax:-27,2— j4/- E-Mail: 4�( Phone No. ? � A161--2/16 Fill in fee simple Title Holder on next page (if different E-Mail: prA . � :L G��1 from the Owner listed above) State or County License: LqCL 11 S If value of construction is 2500.or more,a RECORDED Notice of Commencement is required. SIJP'PLBIt/11ENTAi.CONSI"Rl1CTI"ON LiN 14UU I`N'FORIVI�►TION: 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 covenarits'.that may restrict or,prohlbit 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 ag'reethat I will; ih 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'rion=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'af orne' y before commencingwork or recording .'our otice of Commencement. S ature of Owner/ gent/Cessee ignature of qonactor/License Holder., STATE OF FLORIDA STATE OF FLORIDAi COUNTY OF .).� c COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrment was acknowledge efore me this A5 day of 204 by this day of 20 by (Name of person acknowledging) (Name of person acknowledging) I 0,4A ri �A �It'a_AA Q)\ (Signature of Notary Pub ic-State of Florida) (Signature of Notary Pdublic=State.of Florida ) Personally Known v/ OR Produced Identification Personally Known ✓ OR Produced Identification Type of Identification Produced Type of Identification KARE mmission No. ��°PPY�°° 'State of'Fi IELSE Commission No. SPq PUe, EN S. NIELSEN _N � � otary Public Commi _xo.•: ���$tate of'.F(orida-Notary Publ c: :; o: mission #GG;207484 =* *_ Commission #GG 20748< '�. OFF�oP�� My commission Ex `My C mmission Expire une :2 7.2 1i OF RO� • .�. REVIEWS FRONT "2 "Kir- � SANS VEGETATION SEAT R� VE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED. ev.7/2014