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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: da op-mm LPermitting ilnm -4 1E EtO r Building Permit Applicat01$ Planning and Development Services Building and Code Regulation Divisionai men2300 Virginia Avenue,Fort Pierce FL 34982 n tYr FLPhone: (772)462-1553 Fax: (772)462-1578 Commercial Resi PERMIT APPLICATION FOR: PR©PQSED INRW@UEMENT LOCATION: Address: 3yol 6ji Legal Description: Property Tax ID#: Z4o S_ (.oi - 0o:3n 6 0 0 ; Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED I?E�SCRIPTIQN ®F Wil CC3NS1'RUCTIUN I'NFORMATI®N: Additional work to be pertormed under this permit-check al I that,appy: _Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors C Electric _Plumbing —Sprinklers _Generator L--"'Roofe Pitch Total Sq. Ft of Construction:� � 'Y J��� Sq. Ft. of First Floor: Cost of Construction: $ / �- ©� Utilities: _Sewer _Septic Building Height: OWNER/LE�SSE CON AOR: Name AI t.=S. Jn - �S AL m f N)1�_' Name: Address: Company: City: State��-• Address: ' Zip Code:.3 4 SZ S/ 7 Fax: City: State: Phone No. 7 `7_l - _ D .�_O _70 Zip Code: - Fax: E-Mail: Phone No Fill in fee simple Title Holder on next page(if different E-Mail from the Owner listed above) State or.County License If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. S 'PLE EN L CON51'Ft+UCTION SIN LAW N `ORMAT[IN 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 Associationrules,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. Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORID - TATE OF FLORIDA COUNTY OF '��LQi % COUNTY OF The ing instru e t was acknowledgy0efore me he forgoing instrument was acknowledged before me this for day of 20_ by m-6� his day of 20_ by _o 0 07j) "OAt 'C,50�lnl Oel�'01 Name of person making statement. �s.� ame of person making statement. � T� PersonallyOR Produced IdentificationVal o�A rsonally Known OR Produced Identification Type of Idt:ntificat' ti N yepe of Identification Produced _ roduced (Signature of Nota ublic-State of Florida (Signature of Notary Public-State of Florida ) Commission No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8 2/17 I