Loading...
HomeMy WebLinkAboutBuilding Permit Application 1 ' All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE CCEPTED � Date: Permit Number: 0� . O"( L 40 1011 01 M. Building Per it 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 PERMIT APPLICATION FOR: PROR�SED lNPRC�3UE� ENT LOCATlQN: Address: 7. B G l,". /l D rlve C,i'c 1c A/`t Glc 1'e Legal Description: Property Tax I D.,#: `7 ZrJ' 1© - clog. ©vU Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: D T ILEDIMSAR�I'PTION O WORK: 4 e'-ass zzo yrs re M© iv "6 "S SW/"fcyes OA'al ece • -ac�2 . CON4 TR+11 Tt(3N I!N�ORMATI©N: Additional work to be-pertormed under this permit–c ec a tat appy: _Mechanical _Gas Tank _Gas'Piping Shutters Windows/Doors Alectric _Plumbing _Sprinklers Generator _Roof Pitch Total§4,Ft,of Construction: Sq. Ft. First Floor: 23 © • ,x/. 5.: on ' . •. Cost of Construction:$ Utilities: —Sewer _Septic Building Height: MY MISR&LES�C CON RA TOR: Namez!2'd5C- GaGC Name: D 46 X 4 C�Bw Address: qtr h� _ v �/!.)riri Grs r Comp" ny:_ t /`e) (,,A,21/&­5 /Yc City: Tr State:_ Addre s: //y D 5 G/` 41. O Zip Code:�¢� .Sy Fax: City: /�/,d1,Gl�.' /�q Stater Phone No. 92 -- 'd 7, O 9 ,L1 Zip Co e: 3 '�7d� `/ Fax: N E-Mail: Phone o 3S'2- yD 9^ OS`2 7 Fill in fee simple Title Holder on next page( if different E-Mail 3 y120 1 40 G dlwt from the Owner listed above) State r County License O 00 E-5-3 If value of construction is 2500 or more,a RECORDED Notice of Commen ement is required. SUPPL�MENTAL CONSTf�� STI©N LIiEN LAW IN"F�'R+MATI'O DESIGNER/ERom NGINEER: 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 commencing work or recording our Notice of Commencement. I It _), (AM x4�__ L - r Uy" 74' Signatu of Owner/Lessee/Contractor as AgeRt for Owner Sign ure of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF af. The forgoing instr ent was acknowledged before me The forgoing ins ent wa acknowledge before me; ° this�_day of 20N by this�day of 20 by lo, z � (Name of pers n acknowledging) (Nam of person acknowledging) (Signature of Notary Public-State bf Florida) (Signature of Notary Public-State o Florida) Personally Known OR Produced Identification Personally Known\ OR Produced Identification Type of Identification Type of Identification Produced Produced Commission No. lig ,,,,, ) mission No. (Seal) . Pnvn�a,,l LASHAHNA INGRAM Notary Public-State of Flor da _ 4 ;20 0�,, LA5HAH�f i� " 101. nres uec 2o, ?018 ` = ary Public REVIEWS FRONT �°N((' Con p€RVIS'OR'�9 ANS VEGE *PSEA 1J1 LE�ire`ark (��rK"O` E Zfentled hu na,r^� lotary ISS- ` !.,oFF�°acs �q,,� � J �71'r,r� COUNTE_ W =, �r'EVIEV1j REVIEW REV 5v' � F iRE•U�EW; pion v c a 8u1 a ,�„ ,',1ryAss n.DATE �RECEIVED DATE COMPLETED ev.