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HomeMy WebLinkAboutpermit application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q Q( Date: Permit Number: sn.ra RFcFivFo Building Permit Ap' lication AIIR 09, 2018 Planning and Development Services Pelmitti, Building and Code Regulation DivisionSt' to hepar inept 2300 Virginia Avenue,Fort Pierce FL 34982count,, Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, clic arrow at the end of line °t t OPOSEW*ROVEME IT LOCATtC3N yz " Address: u Legal Description: Property Tax ID#: c�-3�-3-- �-• � - Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: ov � - \�� ��• � Nom+ -• \1 - \'d�,\� A- ion � +a. ti C+dNSTRUCTItI>INF©RNfATION .a ,' ,9,y_ ., •_^'.&.' � _ r4_ `x.� s 5 Y ;x a. 3 h Additional work to be nerrormed under t ispermit-check a pp y: HVAC Gas Tank 0Gas Piping � hutters a Windows/Doors Electric ❑ Plumbing OSprinklers 11 enerator E] Roof Roof pitch Total Sq. Ft of Construction: SFt. of First Floor: Cost of Construction:$ 'S� �l: • �� Utilities:Sewer Septic Building Height: >OWNO- LISS >r� " � CC?NT ACTOR , �. ._ . ,. NameName: e-r�,-9Pe' Address-<!_S%-kQ City: C) -k- State:_— Addres :43S NW Zip Code: Fax: City: State: Pt_- Phone No.`1�"�- �O�-`l�q-1 Zip Cod ��i��� Fax: E-Mail: Phone 0 .-`7`� Fill in fee simple Title Holder on next page(if different E-Mail: to �� �rS t, M from the Owner listed above) State o County License: :�gs�Cc::rl If value of construction is$2500 or more,a RECORDED Notice of Commenc ment is required. 5U 'PLEMEN`fA CONSTRUCTION L1EN LAW 1NiFURMAT CNr f A DESIGNER/ENGINEER: _Not Applicable MORTGP GE COMPANY: Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: le Not Applicable BONDIN COMPANY: Not Applicable Name: Name: Address: Address: City: City: Zip: Phone: Zip: Phone: OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtan a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior to the issuance of permit. St.Lucie County makes no representation that is granting a permit will autho ize thepermit holder to build the subject structure which is in conflict with any applicable Home Owners Association rules,byla s 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. Lu ie 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 Commen ement 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, conult with lender or an attorney before commencing work or recording our Notice of Commencement. I G� Sig ure of Owner/Lessee/ "ntractor as Agent for Owner Signatur of con tr c r Li ense Holder STATE OF,FLORIDA STATE PF FLORIDA COUNTY OF_ S�- _i_z COUNT OF 5- C The forgoing instr•ment was ac nowledged before me The forgoing inst ment was ac_k1n-owledged.before me this day of V.S 20 by this�day of Ani .�T 20 by Name of person making statement ame of person ryiaking statement Personally Known � OR Produced Identification Personal) Known ✓ OR Produced Identification Type of Identification Type of I entification Produced Produce (Signature of Notary Public- tate of Florida) (Signatu a of Notary Public-Statelof Florida) trgY PU TIFFANY SUIT y P� Commission No. r°�"'-�QSea�pmmi�#GW9142 Commis ion No. 2°� I� TIFFANYSUI Expires April 26,2022 * * Commission#GG 1 1 1 9 of F�° SOMA Tm � Nye moo`• Expli April 26, 02 FOF FJ"; Bonded P"BUdget"SC, Cos REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17