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HomeMy WebLinkAboutBuilding Permit ApplicatiuonALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: I I' -11 It Permit Number: 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: Plumbing PROPOSED IMPROVEMENT LOCATION: Address: Legal Des Property Tax ID #: 33ZZ - LDZO' (01 ,u�' DM " 3 Lot No.�? I Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: k,pt0.c-2 Sp CONSTRUCTION INFORMATION: Additional work toe nerformed under this permit - check all appy: j HVAC 1I Gas Tank []Gas Piping _ Shutters Windows/Doors 11 Electric © Plumbing Sprinklers I Generator Roof Roof pitch Total Sq. Ft of Construction: S Ft. of First Floor: Cost of Construction: $ %c gyp Utilities: E Sewer []Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name Name:t'�.]OIYYI Address: 1 3a tNS C, Lk)a\.( Company: 11, �QtY�� Y� Zxe_w S Address: /S9LVs Vj fa py _ LCW%<. PluMb . City: _p+•Sr}-Uuc,e.. State: EL Zip Code: 3 IMco Fax: Phone No. City: `F . 9j4e4C.:2 Zip Code: Fax: Phone No. 172 -1-7 - -L9LO L State: E-mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E -Mail: cuS State or County License: C FQ.114 LO it value of construction is $2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: _ Not Applicable Name: MORTGAGE COMPANY: Not Applicable Name: Address: Address: City: State: Zip: Phone City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: )e Not Applicable Name: BONDING COMPANY: Not Applicable 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 commencing work or recording our Notice of Commencement. Signature of essee/Contractor as Agent for Owner Signature o ctor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF �5-�- , l .UIC.� 2. COUNTY OF S-� . L.i�l `U -4Q. The forjoing instru ent was acknowledged before me NOVf, The forgoing instrument was acknowledged before me 'IV IU0I/CMJPCr 1$ this day of 2019 by this day of , 20 by Gen ` Yxtrr rn J � wve l P.3e r, . rv1:In -6,\ WC, 2 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 o otary Public- State olia of N ar PbIic- State FIA►�ielu3) Notary PublicStateofNotary Public Stator Florida /�' � Angle Tatlana PeroCommission No. —�^ngieTatlanaPe mis 'on No. -1 Z � Js�a yCommis,JonGGOMy Commisslon GG Expires 08/25/2020 . xplros 08/25/2020 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17