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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MLIST'BE COMPLETED FOR APPLICATION TO BE ACCEPTED ^^�^1 Date: Permit Number: !-11ot�� _ 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 \\.6 PERMIT APPLICATION FOR: P �PQSED INPROVEMENT LaCATI' : Address: Legal Description: Property Tax ID#: 3� �� ° OOa.coo I Lot No. Site Plan Name: Block No. Project Name:' Setbacks Front Back: Right Side: Left Side: ETAM D CSCR+IPTIQN Of WORK: X �n CQ C�NSTRUCTIO � (NFOR+MATION: mfionarmo—rK to D e pe orme un er t is permit-c ec a tat appy: i — Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric _Plumbing _Sprinklers _Generator _Roof Pitch i Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ I ® Utilities: —Sewer —Septic Building Height: 0 N E j'to53 E : CONTRA O'R: Name Qi Name: Add ress:9 Loo V uJ)nd&[± Ck(W_ Company: City: '' State Address: Zip Code: ,4 �1 S //Fax: City: State: Phone No-01')9_1 aco ���� Zip Code: Fax: E-Mail. \QQq-}V Ifs Q tt 0)- (011 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. CONSTR C�TIt3N I.I �aN LAW � �ORIUiAT '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 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. aw i k��Q I x'��� X n '(') � A )k CC Signature of Own /Lessee/Contractor as Agent for Owner Signature of Contr Jctor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me this W_day of *J61 2013 by this 19 day of Q39 209 by An OA9 Lr\" AMW1M='- Name of personing statement. Name of persA ma g statement. Personally Known OR Produced Identification �' Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced *,11h" \-� r'Ra SM6 (Signa ure of Notary Public-State of Florida) (Signa ure of Notary Public-State Florida) Commission No. (Seal) Commission No. S LASHAH�.�„e{�'RAM Notary Public-State of Florida My vul-11. U SHAHNA INGRAM R f 'n +o c,on 41 f F 177249 REVIEWS �F ,+QNTtotary �,Z©.N[N of FI ryp�p�ERVISOR PLANS VEGE A+ �o � $� o� � �ti;i1131 ��y(aROVE e a 'GQ°IDI;TjFjZCorrmREl/1E•'•Wec 2D 2a'iREVIEW REVIEW REV EW ,. REVIEW DATE om i- , RECEIVED `y "" Bonded t irou,gh National Notar Assn. DATE ` ^ V COMPLETED Rev. 8/2/17