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HomeMy WebLinkAboutdavisALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: - )- L e 1 0�-- - - 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: To Select from dropbox, click arrow at the end of line PROPOSED IMP'ROVEIVIENT I.00N; Address:Legal Description: Description: [�r__ deS �� = ,� (� Al Property Tax I D #: ` _ _J 0 © 1_ 0 0 tD 0 � Lot No. Site Plan Name: Company: Q1=11PI C_ 4 : '0 City: — State: F+(__ Block No. Project Name: City: a r; State: r C� Phone No. ` ;� ` 0 " -- J-1 Zip Code: _ J__ 3 _ _ Fax: Setbacks Front Back: Right Side; Left Side: E -Mail: (—, from the Owner listed above) DETAILED DESCRIPTION OF WORK: ] 12 - CONSTRUCTION INFORMATION: _Aditiona wor to e e ormed un er t is permit --check a [lap—ply: NHVAC Gas Tank ❑Gas Piping _ Shutters Windows/Doors Electric Q Plumbing OSprinklers Generator Roof Roof pitch Total Sq. Ft of Construction: C T� Sq. Ft. of First Floor: Cost of Construction: $ _Lf7:>`Utilities:11Sewer 0Septic Building Height: OWNER/LESSEE: CONTRACTOR: NameC.. �-v-. ° _ � Name: Address:_ J 3 k. -j 5 Company: Q1=11PI C_ 4 : '0 City: — State: F+(__ Address: Zip Code: 3 q C Fax: City: a r; State: r C� Phone No. ` ;� ` 0 " -- J-1 Zip Code: _ J__ 3 _ _ 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: C—y 51 vglur ur cun5tru"ton is ,;;oLSUV or more, a Ktc umutu r4otice of commencement is required, SUPPLEMENTAL CAIN,U - TiON,QEN lAWlirll�QR �4T�� . ` 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 commje-qcing work or recording our Notice of Commencement. ignature of Owner/ Lessee/Contractor as Agent for Owner Signatu of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF S`; L L� c., '(__ COUNTY OF S 7— The The forgoing instrument was acknowledged before me Theforgoing instrument was acknowledged before me this,; day of __ 0 c__c . 20� by this .9i day of {] c. c 20__Ldrby Name of person making statement Name of perso ,making statement Personally Known — OR Produced Identificatio Personally Known OR Produced Identification Type of Identification Type of Identification Produced i Produced nN0 f rTl C) Up Z (Signature of Notary Public- State of Florida } (Signature of Notary Public- State of Florida } �-o (Seal) ... � � Commission Na�� Commission No, } � � �S (seal} �,or REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17