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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 9'-a131ge Permit Number: I8O-I•OUA.Pea-1 } ;r �, ;' F L C) R. 1 D ,_ 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 _) PERMIT APPLICATION FOR: PROPOSED OND R®VEMERF LOCATIO ,g ,• . = Address: 1002, SFIABTIA.N T<DA0, ' elitr Q[FR,E 1 fl-- 340151 Legal Description: Property Tax ID#: 1301 .. ll1)3. 0309.000- Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: . Left Side: 11AILED DOCR PTI® OF WORK .: . lar reIbi ti-T1c A-L &1 14•Rtot ti, 8ODWq 1 _ T .. 'C®NSTRUCTI® 11 jP ©RMATIONo .. . Additiona work to .e performed under this permit-check all that apply: _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:$ ((0 °� Utilities: _Sewer _Septic Building Height:, 1' OWNER/LMS :E CON °ACTOR° Name 04146•0 NE TA-0 tiliks Name: vujN _' Address: 7ooz sEBAs-nAN 30Ar0 Company: City: -Fr. Pl>k 0.1 *L StateL Address: :.i .•.^ Zip Code: -3495-1 Fax: City: State: Phone No.`(7 2 34-9 - 8gj09 Zip Code: Fax: E-Mail: 4. •• Phone No Fill in fee simple Title Holder on next pag ( 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. SUPPLEIVIEN CONST°UCTIC1N L 11 I 'FOR,, AT CI`N ' ° :,-. - ` 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 makesono,repre5dntationthat is;„grpntingg a permit will authorize the permit holder to build the subject,structure which is in conflict with aray'app_ able Home O'wn'$rs'AsSoci81'i: rU7es,bylawsor•'and covenantS`that,rnay;•Festrieb1-prohibit such structure. Please consult with-your Home Owners Association and review your deed forany restrictions which may apply. In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work in accordance with the approved plans,the.Florida Building Codes and St. Lucie County Amendments. The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attorney before commencing work or recording your Notice of Commencement. , 11111 .4i I►..riet11ati ...w-i Signature ofOwne`/ essee/Contractor as Agent tor Owner :- Signattserof,Coniractor/License -Iplder ,. r , STATE OF FLORIDA STATE OF FLORIDA COUNTY OF _) COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before mes thiday of ,201i by this day of ,20 by 0_,ili\ e. ,,li ) Name of person making statement. Name of person making statement. Personally Known OR Produced Identificatio\n J Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced 0 'I . ' (Sign.ur- of Notary Public-Stacof Florida) (Signature of Notary Public-State of Florida) Commission No. r. , o .i--•(S'ealf :�es .^ `$'a,: t ".t„..:s *- Commission No, ` % 1"). �,a��p++.�, LASHAHN,4INGRAM -• 4 ..; • , • + ,s -, or,4.. Notary Public-State of Florida �" 1•E My Corn.tx{.tiebuec2.0,iuia .. • 4 ?wPte` iE6101 n Fc i7 inn P`i • . REVIEWS FRph1�X'roFF,•.•`� 5i SUPER'Y,I O PLANS VEGETATION SEA TURTEE ,MANGROVE o tough IJauo ? vn a. s11 COUNT-E R F2 VIt- - REVIEW 4EtEVIE.W, - REVIEW,. ,.. .REVIEW DATE :.., . ':;E; RECEIVED , ;I.'..4;i) e, q,‘.--:*:•••• •,.. _p,:',,eat)i.''t7 it'l , i`' DATE .. COMPLETED Rev. 8/2/17