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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ^(� Date: Permit Number: 10� O � LM J ° E M: a r 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 i PERMIT APPLICATION FOR: PR©,MORS' hN RaUEMENT LOCATIt?N: Address. fE' -P` I� o A � J cc L H l Legal Description: Pro perty Tax ID#: 3,10 y — 5 3o —d 17—Z — O C1(-/ Lot No. Site Plan Name: Block No. Project Name:, Setbacks Front Back: Right Side: Left Sider DE AILED D +'PTION OF WQRaK: Pl� 10 du cnn 3 . 5- k r eA/( S-K,s4 e/7, w/ 10 K CCONSTR,MC T1 I(�3N ,NFORMA 0,P, idclitio al work-to be pertormed unclert is permit—check 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 NER/LE=�S`�SFE: CQNTR CTOR: Name 769, _ApKytm Name: Address: 6$ I'-st &Cpcv'� r� Company: C_ State:FL Address: /9�/�r SW S w; Ave. 'Zip Code: c/� 5�-J Fax: City: NS L. State: jL Phone No. -7-7;7 — 23 7— 7SS 7 Zip Code: 3W53 Fax: E-Mail: V Phone No 772 r 3Z3— 30 Za Fill in fee simple Title Holder on next page(if different E-Mail ;from the Owner listed above) State or County License ItIvalue of construction is 2500 or more,a RECORDED Notice of Commencement is required. I; • S-MARVEMJRICTWIN NI LIEN LAW INFORMATI(�3N: 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 thepermit 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. ---------------------------- Si a e o Owner/Lessee/Contractor as Agent for Owner- Signature of Contractor/License Holder STATE OF FLORIDA l STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this1k15 day of 20AZ_ by this_1&_day of Z� 2dJ__ by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida ) Personally Known ,� duced I'demtifieab6t�rrR7Fida „ Personally Known O P o ed_Identificationz-'.-�-�� .'� Notary Public-S4a4e Type of Identification ,,�������„ I_ASHAHNA INGRAMType of Identification ' ='2,* , a,, ,Produced t ,*'c My Comm.Expires Dec18 Produced •° `c'= Notary Public •�4ate of Floridaac, ommission #�FF 1 ; ;•_My Comm.Expires Dec 20,2018 Bonded tour' ^; "�,; ;«ar„,ssn Commission No. ^,T Com ey FF 177?_49 Commission No. - ,_. ,Aea1) (�9 ) Bonded tfirough(tlat onaI Notary Assn.' REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 7/2014