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HomeMy WebLinkAboutBuilding Permit Application All APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED � Date I GPermit Number: (oa JD� RECEIVED M FEB 0 71019 Building Permit Application Planning and Development Services Permitting p�pament Building and Code Regulation Division St.Lucie count 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: �. � ©N L PRQPOSED I'IU�PR41lEM�ENT LOCATi"ON; " Address:( wmnin� wa4 Le alescripti lab �'1 n: II 0 C Property Tax ID#: r Lot No. Site Plan Name: .�a Block No. Project Name: \ o U 0 Setbacks Front Back: Right Side: Left Side: DETAILED DE�SCRGPTION OF WORK; Y k CO Dri MDT tc N( I q C05TRUCTIOj 'N.F®R+MATRON: Additional work to be pertormed 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: C2, D Sq. Ft. of First Floor: Cost of Construction:$ L, d Utilities: —Sewer —Septic Building Height: OWNERESSE CONTR cow k7 i O Nam e Name: J . Addre s: Company:- - - City: State Addr DC Zip Code- ax. City:VtP AcStater Phone No. ,� Zip Code: Fax: G3 E-Mail: Phone No Fill in fee simple Title Holder on next page(if different E-Mail i yi D e from the Owner listed above) State or County License If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTA CONSTRCICTION LI �N LA INFORMATION: DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: 1 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 jthe 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 sof the`granting of this requested permit, I do hereby agree that I will,in all resp4ects;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 accessoryuses 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 •r-'ecorded 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. E ' nature;of Owner/LessleEVContractqrjas,Agent for Owner 1 "Si—,iure of Contrac or/License Holder STATE OF.FLORIDAr\ ' ) STATE OF FLORIDA COUNTY OF J' tom,(C� / i COUNTY_OF \- 5 kL, ,�U__ The forgoing instrum nt was acknowledged befor`me The forgoing instrument was acknowledged before me this day of 20_0 by this day of 20q by e h d el us 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 , ProducedProduced FA) �1 §.'lr6tU7re_of Notary Pub i � �Qfv�r �oriria-Notary Public LIN WAUUMN (Signature of Notary Public ta�Y��1 loridaaLLEN VAUGHN j i '* ►_ Commission#•G`G 270079 I i ( + I *� `� StsteI of$Florida-Notary Publ c = oar 1 Vin.\.., i g Commission No :�F oe,� tvlKjmission Expires Commission No. �.•. QP:'CO lon;#-Gb 27007 i Octobe`r,22, 2022 f :;, , , ��.� mission Expires I b Otobe'r�22, 2022 `_ _ REVIEWS FRONT (ZONING `` SUPERVISOR PLANS VEGETATION SEA-TURTLE MANGROVE COUNTER `,REVIEW :REVIEW REVIEWREVIEW ( REVIEW. REVIEW DATE - - RECEIVED DATE COMPLETED. Rev. 8/2/17