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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: t g F ermit Number: Building Permit Application i 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 PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION' Address: .25-0 Vrc� `.• �. ,e Ge �L 1 Legal Description: �v 19Gt S L- Property Tax ID#: 3-1 DS- &D L n0M, n Q n- I Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION-OF WORK: x 7 11,CO- IBX 7 �l�e � Dooms peLf^l* IY)C CONSTRUCTION INFORMATION: Additional work to be nertormed under this permit-check a apply: HVAC Gas'Tank Gas Piping _S hitters Windows/Doors ElElectric ❑S Electric ❑ Plumbing ❑G�nerator ❑ Roof Roof pitch — — prinklers — — Total Sq. Ft of Construction: S . Ft. of First Floor: Cost of Construction: $ Uy Utilities:CnSevJer ESeptic Building Height: OWNER/LESSEE:. CONTRACTOR: Name C_,,J em e_1 DoK- , ( Name: k G 6'C6� ctnr- & 4'5 LL L Address: ?_ (,j I c�' CoRipany: G, _E.05/ City: C_ �,�� State:kL Address: k W v`i'(,. c2 �✓ Zip Code: 3y CI''f' Fax: City: State:_A�L Phone No. C1 q- STS- 5-.5-(a Y Zip Code: `{cl V3 Fax: ,E-Mail: Phone No. ?7z - a(97 536 Fill in fee simple'Title Holder on next page(if different E-Mail: door P�rtS ya�ho o• c from the Owner listed above) State or County License: 0-y7 q If value 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 obta n 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 t at 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 m st be recorded and posted on the jobsite before the first inspection. If you intend to obtain financing, con ult with lender or an attorney before commencin work or record' ur Notice of Commencement. l � Q � Signa ure of owner/L ee/Contractor as Agent for Owner Signature of contr or/License Holder STATE OF FLORIDA STATE C�F FL IDA COUNTY OF w5t- Lue, IF COUNTY OF 5-t- k-,c r The forgoing instrument was acknowledged efore me The forgoing Instrument was acknowledged before me this�day of Jy/_ lL 20J�by this 17 day of J Cr /o ,20/?/by I©�� G- Name of personyaking statement Name of person making statement Personally Known / OR Produced Identification Personally KnownI,"'OR Produced Identification Type of Identification Type of Identification Produced Produced i (Signatur f c- a of FIorI (Signatu PATRICIA HERLEHY Comm si '";' PATRICIA HERLEH Seal Commiss `�' Y (nrt R ) ,ns Notary Public State oft r°. .o; Notary Public-State of Florida i My Comm.Expires Sep 1, _'•: :•= My Comm.Expires Sep 21,201840 FF 19qqng =".9' 'o;= Commission# FF 12990E e ° Bonded Througli National Notary Ass: REVI NUS' SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED' DATE COMPLETED Rev.8/2/17