Loading...
HomeMy WebLinkAboutBuilding Permit Application ,TALL APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I Date: Permit Number: 12, I RECEIVED Building Permit Application DEC 0 5 201$ Planning and Development Services �T, Lucie County, Permitting Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 / Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential 1� PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROV_ErMENT LOCATION Address: �� EC140 Legal Description: 4 0 &AY 101 NF-_% Z O 1, - 15 -1.O T-_ �Z "AP J 3117- s .. 49/2- 1266 2(ad 0 /3-5 7 17-59 Property Tax ID#: IS �i�/ �t��SS - ®®© - O Lot No. Site Plan Name: Block No. Project Name: setbacks Front Back: Right Side: Left Side: DETALED DESCRIPTION O'f WORK I CONSTRUCTION INFORMATION itiona wor k'to . e nertormed uncler this permit_chec a appy: 1HVAC0 Gas Tank 0Gas Piping _Shutters Windows/Doors []Electric . ❑ Plumbing Sprinklers ❑Generator Roof Roof pitch Total Sq. Ft of Construction: SFt. of First Floor: Cost of Construction: $ Z 72• Utilities:cn Sewer[]Septic Building Height: OWNER/LESSEE ; ' CONTRACTOR F._f Name AA1/275' Name: r I- L. a Address: m 0 _&40 fiW65 at R_ Company: City: r--r- Stater Address: 3 (k� 14W Zip Code: & .qo� Fax: City: State: L Phone No. -17 Z. ` J-13 , S q 24 0 Zip Code: 3Z!F Fax: 7 ZZ-!544 -�09 E-Mail: AN'0$eJr�{-idgJVS[8_/4OI'1-1-4/`-+�!9)?/f Phone No. 777-1Sf�2- t�D Fill in fee simple Title Holder on next page (if different E-Mail: o� G L�>r�aUff�'I/rtJt�®l�+ from the Owner listed above) State or County License: If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INF#ORMATION 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 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 fir t insp ion. If you intend to obtain financing, consult with lender or an attorney before commencingork ording your Notice of Commencement. C� Signature of Owner/Le!see/(-nra or as Agent for Owner n ure Con " tor/License Holder STATE OF FLORIDA II , STATE OF FLOR14A�, n COUNTY OF IAckan �Ver r COUNTY OF //16 �A vex- The forgoing instrum nt was a knowledged before me The forgoing instrum nt was acknowledge efore me this day of 20�by this day of 1/ 20/ by 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 Amn 111i P, /,40,9# e"Yw"- A4 (Signature of Nota Public-State dAloricla ) (Signature of Notar ublic-State o orida) �v ruk�o DOROTHY C LEGGETT Commission No. act 5 eg! mmission#GG2b6928 �/� . , DO sslon#GO2569T (,S � Commission No. 3 , � (���Ieslon#GG 266928 N, Expires September 19,2 .�,� d Expires September 19,2022 �COFf1.0g11 BwAddlivusudgetNawy �rFOFFLOP� BondedThraeudpetNOWyamns REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17