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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Ij Q Date: Permit Number: �`Zn� Building Permit 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 iPERMIT APPLICATION FOR: Window/door PR©P©SED IM ��NT L�o� Al®tN, / p -3Yj Address: 12 I- JJ�� OA)- �T, L"I GL ��.qg'l Legal Description: ,D®D ?,.j��11.2 R B-948__)R_ 1 ,6�f- (5j1 co& k0 IProperty Tax ID#: I 6 -OC6 qLot No. Site Plan Name- Block No. Project Name: Setbacks Front Back: Right Side: Left Side: IMILC0 ,1ES @IWI2N ®F W©RiK: .Y TN 91-L TM Pricf- FrPUT 1j `f L z� - I - CONSTRUCTI®N UNF©RMATION: ,._ .;;R. _, . . . �.*... It Additional workto M orme un ert is permit-c ec a appa❑HVAC Gas Tank Gas Piping _Shutters a Windows/Doors ❑Electric ❑Plumbing Sprinklers ❑Generators Roof Roof pitch Total Sq. Ft of Construction: S . Ft.of First Floor: 73, /a 15' Cost of Construction:$ 1'5Ct 5-• DOD Utilities: Sewer Septic Building Height: t" tE''s K < h -NOW t h*�f.. ' ®WNERj/LE��SSEE� � �� CO.NTR?ACT®R: _ � � I Name $ I/RA Pf' 14 OP if �'�' Name: Address: �61p� '1 c� r AILR�'!' )L-, Company: City:-PIA+�'�. J.�VGZ&_ State:FL- Address: G S' �� tw�7,1 ' Zip Code: Fax: City: State: Phone No. Zip Code: S�li 7 6 Fax: E-Mail: Phone No. 7'32-- Z( 5?�� sp Fill in fee simple Title Holder on next page(if different E-Maiksym. (' ]�v �.� 12- 1 W-6 from the Owner listed above) State or County License:CAL IZ AQ- 62- M If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. �. P6&y! �. a �� 3;#93:i %.�� .t_` '�, .. Y� T d���� '' rn '.S € � � �h r'yj.t� �� aEFr t�'�',���'� � ra•¢ 4 -, xN" S�UPPLEMENT�AL�CS�TRUCTION�LIEN�L�AWsINFORM�4TI®N � �_. _� � ,trs �� �; Ry." DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: Address: Address: City: State: City: State: -Zip: Phone Zip: Phone: FEE SIMPLE TITLEHOLDER: _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. 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 i I n 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. Si ature of Owner/Lessee/Contractor as Agent for Owner Sipiature of Contractor/License Holder STATE OF FLORIDA ` STATE OF FLORIDA COUNTY OF ,h� �1�,o COUNTY OF VC\&4,r The forgoing instr ent was acknowled ed before me The forgoing instrument was acknowledged before me this day of 2by this—)!!day of e6kr % 20ft by _ 1JI�G11Q S �u.0 S Name of erson making staterAent NAme of person making statement Personally Known OR Produced Identifications Personally Known OR Produced Identification ROL- Type of Identification Type of Identification Produced Produced CAA, MJ)li iU170 4L MAUREEN P DETHORNE (Sig tur of NotaryPublic-State of Florida) nature o Notary P * *t7 F1 916 Jublic-State of Florida � . E, - .•; Commission#FF 230881 Commission No. ,�����•„ LASF(Seal)INGRAM Commission No. -a 3l) P�°o' My Co Aires May 14,2019 ••�����•• Banded lhrcugfi National Notary Assn. Notary Public-State of Florida * " •_My Comm.Expires Dec 20,2018 � I ,.=My E FF 1777.49 fl� ed through plat anal Notary Assn. REVIEWS ROI , LNING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE l NTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.8/2/17 i