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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: � -1 ©0q.q) 4 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: PBQP1OSED INP"R®uE�M.ENT LO.CATIO'N r Address: Legal Description: Property Tax ID#: o•oas�- .000_� Lot No. Site Plan Name: Block No. Project Name: f;5 - Setbacks Front Back: Right Side: Left Side: DFETA;LED DE�SC °h TION'-OF*V1/OR'K� � ° CO`NSTRUCTIO'N INFORM TION; §. Additional work to be per orme , under this permit—CheCK all that appy: ,,/—/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: $ Utilities: —Sewer —Septic ,Building Height: 0�� 11�1/,NER/LESSEE: � �C� TRCTR�- Name %n✓a ?f-g;",Voy CSS Name: Address:?'7,Z c:.f��5�z)cels Gi�?CE� Company: &_L-G g City: s�Ta%.i�,r_J'A. State:� Address: Zip Code: 3 ZS2i Fax: City: Stater—� Phone No. 8'r6— ���, °l/ ! Zip Code: Fax: �— E-Mail: Phone No_ Fill in fee simple Title Holder on next page(if different E-Mailr from the Owner listed above) State or County License 2.S 7/2 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. l { �51 'LEMON: DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: Address: 'Address: City: Stater City: State: Zip: . fPhone 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 Counter 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 plan's,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 WA,RNING 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. . Anz A 4. Signature of Owner/Less a/Contra for as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA • � STATE OF FLORIDA i COUNTY OF-' s � CQUNTY OFP,- -The_forgoing instru t was acknowledg d before me The for oing instrum nt was,acknowledged before me this day of 20'6 by this 1`k day of t 20M by (Name of person acknowledging) (Name of person acknowledging) S' nature of Notary Public-State of Florida) (Signature of Notary Public-State4 Florida) Personally Known_,- l OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced ,,ay r LA"'IAhINA INGP,AM Commission No. == Commission No. `� _2tn "«< Igo�arya�1blic-State of Florida t �Pii�4, aI) 8 z `�20� e�• LRSi1AHAiA.INGRAM My,Comm.Expires Dec 20,2010' _ *� Notary Public.S1ake o'7 FI rli 4 tY, ) p ;�T �•�, ,a" t Q; pins Dec 2D, Qdfhro 0 ^naJJN lar Ass 1.l " � C U-1j, DREVIEWS FRONT ff� SR-T=PLANS VEGETATIONSi', �i,` t�LndelftOV+E�COUNTER ' REVIEW REVIEW REVIEW REVIEW R' VIEYNJEV11!Notary DATE RECEIVED - - DATE COMPLETED l—ev.7/2014