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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 1"1 Permit Number: C/ _ 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: PRAOPOSE1 INPROUEMEUS IN OW- 01ION: Address: 6 6 a3 C .i'I'.��.5 , r f Q ck �Q Legal Description: o 'F Q! • ice c�J©©ce Property Tax ID#: 130 6 l— y O O d " 7 Lot No. 1 Site Plan Name: Block No. l Project Name: Setbacks Front Back: Right Side: Left Side: /S — QE ILED DESCRIPTION 0 WORK: �� oo rin. / cl���`h Y? C-Ck e 1° ! J`r'V w O ' z. aoo e 5 1 is 0TION 1NFOR (ON: itiona wor to a pe 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:$ e6 d Utilities: —Sewer _Septic Building Height: . NFR/LEG EME'NTRA 0R: Name 03n e.w�c j..2. Name: �(�rlc 1�� C�cQo M Address: 6 o C� H`�c. tP�r�� U Company: o 4e�/`k � CD City:. yt1�- ��`CSC Stater y3�Address: � o� c r'C/C Zip Code: Fax: City: c�<- 'State:tP-- Phone No. 7 7a —�`7 p G Zip Code: 3 A ,2 G Fax: 27D, 07� E-Mail: Phone No y7 -3 Q v G Fill in fee simple Title Holder on next page(if different E-Mail A46 cQ p IM 4-6 A ,C from the Owner listed above) State or County License Cd C® f :�r'6 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. WJ.Pj I I fflfl W I B&TJ1 9TIQN 01F I S'10,0MA IAN: 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 commencing work or recording our Notice of Commencement. Signature of Ow r/Lessee/Contractor as Agent for Owner Signaturf Contractor/License Holder STATE OF FLORIDA. STATE OF FLORI •P , ,CI� COUNTY OF COUNTYCIF 141 The f ing instrurent was acknowledge efore me The f going instru ent was acknowledge before me this day of 20Lby this day of UflN 20'c 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 Identifica Produced Produced It A AA c r� (Signature of Notary Public-State of Florida) (Signature of Nota - f Florida `EYP', ' 'KAREN S. SEN ;`.�`vs��PJBo KAREN S Nl LSEN Commission No ,t� �B, ( Commission No. ,2° �'=State of Florida���46 _ StateofFlorido o ry Public ry Public =` Co # GG 207484 Commission # GG 207484 :; s'r` %o °a° My Commission Ex iro June 12, 202 " une 12, 2022 REVIEWS ISOR PLANS VEGETATION VE COUNTER REVIEW REVIEW REVIEW REVIEW. REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17