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HomeMy WebLinkAboutBuilding Permit ApplicationI . All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 1/\l' 1 Q1-\D Permit Number: 8 O!' b Cows NI Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 I Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: PROPOSED [1f11PROVEM LOCATIO- = . . . ., , Address: .a: CA IP kad' p Rf Legal Description: Property Tax ID#: d. 1-1 Cif ` (50(2 of t 6 000 r ' Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back:_ Right Side: Left Side: MAILED DMCR PTI®N CF. ORK° -.-4. 4.. a : q' - L__)c c c c it a OS '_ a '(1� ail • • _ d 6 0 • `1P_f: '� a s v_c' • �,0 (A7 ( ,.2 , 1 P / `C )NSTR CTI o N fN1=ORMATIO a :; "' Additional work to •e performed under this permit—c eck all that apply: I _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:$ 1 5 CO Utilities: _Sewer _Septic Building_Height:1 1I O, V'iaR/LE=�S�-SE CONTRAGT©R° , Name ‘a (ip\-Ck_`41 nP� ` / -vName: Address: ( LXC .lci- V � Company: City: \ef_ State: l Address: . . , ; , � Zip Code: S `\l ? Fax: City: State: Phone No. - 1 LTO —(9 Zip Code: Fax: • E-Mail: / 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. §UPPLE M. L C'®NSTRUCTI©N aMNIPORMATI(3 Q . -. 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 represu sentation that is granting a permit will authorize the permit holder to build thesubject 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 Commencementmust 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. S tu "o O nerLese C nb tractor as License Holder Agent for Owner Signature of Contractor /License g / STATE OF FLORIDA�A_ Li) STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledge before me The forgoing instrument was acknowledged before me this 2-1 day of N9011 ,20 OW by this day of ,20 by f`11 Nri a OVA/el/ Name of person making statement. Name of person making statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of IdenU icatio , _ Type of Identification Produced JF Produced di IllkidivA - ...,_ (Signa ure of Not:`yeu)jc-Statea tL l t UGHN, •-(Signature of Notary Public-State of Florida ) will < State of Florida-Notary Public * - Co,mmissio M 270079 Commission No. = .,.,,..�- • Comm ssiori Expires Commission No. (Seal) ',nni"` Oetober 22, 2922: - REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE . RECEIVED DATE . COMPLETED ev. 8/2/17