Loading...
HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ( (� Date: Permit Number: ' " � � y, 3 KAW-0-21-49i-elm. 0-0 Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Plhone: (772)462-1553 Fax: (772)462-1578 Commercial Residential. PIERMIT APPLICATION FOR: a- �.� l �, �, LA PR POSED INIPR01lEMrENT LOCAT 4N; r4l "0 Address: �`t ` ` Q �, Legal Description: Pri perty Tax ID#: ��dLI ©� ��— UU��� Lot No. Site Plan Name: Block No. Prloject Name: Setbacks Front Back: Right Side: Left Side: I to DE AiiLED DE--�C�RIPTiON � F ORK: �{� CQ 'STR�UC IO I(Uf'0'RMATION: . Additional work to be pertormed under this permit—c ec all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors Electric _Plumbing _Sprinklers Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ Utilities: _Sewer _Septic Building Height: 0 W14NIE �SSEE: CONTRA OR: Name Name: ' (M t; Address: C_�U . Company: 11�9J _ City: 22�cc nn P_X'L State:_ Address: Zip Code: Fax: ff ,�,, City: State: Phone No. �``��' 24L)k — 7= LD LD Zip Code: Fax: E-Mail: ,�N-\ �� 01) • Z--D VV 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. _ I n SU PL�MEN1'AL CC7NS RUCTIfJN U+EN LAW I�N'F©RMATI,UN: 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 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 commen ' work or recordi our Notice of Commencement. Signature of Owner/Lessee/Contractor as Agent Owner Signature of Contractor/License Holder STATE OF FLORIDA ��.. pp STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of 20_ by this day of 20_ by Name of person making statement. Name of person making statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced (Signature of Notary Pub a} Signature of Notary Public-State of Florida) r4i, LASHAHNA INGRAM Commission No. �2°• 4'�': NJy&F)ublic-State of Florida ,ommission No. (Seal) •+ My Comm.Expires Dec 20,201 iNl• r� °ra' Commission #FF 177299 i' •�����• one r ugh National Notary As;n. REVIEWS FRONT ZON`NG "SUPERVISORPLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW ;REVIEW REVIEW DATE RECEIVED . DATE COMPLETED Te—v. 8/2/17