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HomeMy WebLinkAboutBuilding Permit Application (2) 'ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit dumber: t 1 oo h-t SO- n 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: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT`LOCATION: 4h Address: Z7 se -1-y Ino c I i 4 -el Legal Description:aojtf,� r�V � �kcc,r— Property Tax ID#: 3�{ I "' " �) y�` ! Lot No. Site Plan Name: Block No. Project Name: Van 1Y6 Setbacks Front Back: Right Side: Left Side: DETAILED:DESCRIPTION OF WORK: 1rlS c �l twin �� � ©> `? nL C\01\. I.0 INFORMATION: Additional work to (e'ne orme un er this permit-c ec at7ly: OHVAC i�iGas Tank ❑Gas Piping tters a Windows/Doors nElectric 0 Plumbing Sprinklers FIGenerator Q Roof Roof pitch Total Sq.Ft of Construction: S(7' Ft.of First Floor: Cost of Construction:$ 53 J� � �� Utilities:Sewer Septic Building Height: OWNS /LESSEE: CONTRACTOR,-.- Name ONTRACTOR Name _ w/ Name: Ykay Address: SG '��C UI 1 ' Company: � ",f'11 �(1LVY\ti�1.t.W City: -L- t State: �`�- Address:.5n-n� IV W CV�)kf"i1SC Zip Code: 940)i063_ Fax: City: P&_L_ State:__�:t _ Phone No. Zip Code: �l.A E-Mail: Phone Na __242--0400 Fill in fee simple Title Holder on next page(if different E-Mail: �,C�__�[Y11�(� uf'V1CYl�t CG from the Owner listed above) State or County License: C PJ(--.MS...3 I 1 If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. i a .--5 ' {, ,w�z ",� t � �""'-'-�. �:..:�, ..;.t1Nk4'* 7� �4.''�' �"a :a�� <t 4'rS�;:� � »'�r a-�^,ki n��4�r�d•�i .�v'�s<4�< vk .,y���'�$ ,��15;"� �P�: DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable Name: Ek /a, Name: Address: 2AVI - ! Address: City: Stater City: State: Zip: A 4-2- 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 Count 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. i 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 commencinR work or recording our Notice of Commencement. Xd Signature of`Owner/Lessee/Contractor as Agent for Owner Signature of Contract /Lice se STATE OF FLORIDA,4- STATE OF FLORID ,1 I A COUNTY OF �} •L .E.lZ. COUNTY OF_ L 1 [ The forgoing instrument was acknowledged efore me The forgoing instru t wa ack owfedge efore me this day of �Q.� ,20�by this<�L day of_���1_.20��by La_ K-0-ndi-0 lavt 1�&r" Name of persap making statement Name of person making statement Personally Known V OR Produced Identification Personally Known -1"" OR Produced Identification Type of Identification Type of identification Produced Produced (-'Am 'L au'UL4�A� al L igna re of Notary Publi to of Florida) 4ig re of Notary Pubfi - ate o Florida) Commission No. {Seal Commission No, (Seal) o ar aLs, Notary Public State of Florida _ �' Liza D Mayfield ot9aY °oma Notary Public State of Florida o` y ommissi ;�O�UNTEOR 0 9 c. oMy Commission FF 243393 REVIE4�s*�`71 SUPERVISOR PLA S° G yi UN112 1SEA TURTL MANGROVE ! REVIEW REVIEW REVI _ `" REVIEW DATE RECEIVED DATE COMPLETED J_ Rev.8/2/1.7