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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number. r L7 RECEIVED Building Permit Applica ion JAS Planning and Development Services 2019 Building and Code Regulation Division Permittin 2300 Virginia Avenue,Fort Pierce FL 34982 9 Qe ai't171C'11t Phone: (772)462-1553 Fax: (772)462-1578 Commercial Re illucie Unty, FL PERMIT TYPE: Address: 322( I/ vr.. ©Gk i'zy Property Tax ID#: �-2 V_3 U- 3-02 , OV 's- , c c 0 Lot No. Site Plan Name: pj Block No. Project Name: l)l>✓n v�uiJ lhcC Additional work to be performed under this permit-check all that apply: ,�,� _Mechanical ^Gas Tank _Gas Piping Shutters _Windows/Doors Electric —Plumbing Sprinklers _Generator Roof Pitch �-F6t94-6q.Ft of Construction: Sq. Ft.of First Floor: Cost of Construction: $ :�f Utilities: —Sewer _Septic ui Height: Z1 Name /Cir+Ll, '�-t/7d�flv1 Name: ad�� tiic,yl� c�p/rr,t1/r } LGt� Address• ')3 Z-1 h*Vr Ocit 11V Company: 11(151:n 1 City: r-od F,e.vrc State: .�C Address: Zip Code: t '4s / Fax: r City: VC/-Q }{c'�c G, Stater Phone No.--7-7 2- 'I 71 7 2°J / Zip Code: -7-�Z?G Z Fax: E-Mail: r--63 -1 u,q ( ez0/ , 6 d.vvN Phone No ?77-GS01-9 7 6 Fill in fee simple Title Holder on next page(if different E-Mail 13c41'rac vr..tr�.4 c nes S0 from the Owner listed above) State or County License 'SQ c/yJ If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required. 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 first inspection. If you intend to obtain financing, consult with lender or an attorney before commencing work or recording your Notice of Commencement. Signature of Owner/Lessee/Contractor as Agent for Signature of Contractor/License Holder & MK -< STATE OF FLORI STATE OF FLOR!tj COUNTY OF COUNTY OF CD 4 M1 _n kp inst m tw9,Q Ln The forgoing instrument was acknowledge before v. R, The forgoingas acknowledged before r44�r4 SE this day of C�u'-") by this day rn�g rn a, 204 1:iy "Co-< i8ii hoazT; h) P�h A le L, Name of person making statement. Name of person making statement. Personally Knowe.— OR Produced Identification Personally Known OR Produced Identifica Type of Identifica ion Type of Ide UiL Produced C1 Produced r"Ift'l .-, . dc L (Signature of Not6ty Public-State of Florida ) (Signature of Notar6hublic-State of Florida Commission No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED R_ev­.