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HomeMy WebLinkAboutjunkALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED — Date: Permit Number: Building Permit Application Planning and DevelopmentServices Building and Code Regulation Division 2300 Virginia Avenue, Fart Pierce FL 34.982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR: Commercial Residential To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION: Address: b Q S, Legal Description: _ -Se-t- P —I 0 Property Tax ID #: 1 S-0 C Y- "_a o 0` i Lot Na. Site Plan Name: " Project Name: Block No. Setbacks Front Back: Right Side: Left Side: 'LDETAILED DESCRIPTION OF WORK. ' C CONSTRUCTION INFORMATION: INFORMAATION: ttiona wor t© flas rmit -c ec a appy: YHVAC Tank DGas Piping Shutters Windows Doors 1-1 Electric ® Plumbing Sprinklers Generator Roof Roof pitch Total Sq. Ft of Construction: �� � p s--� Sq. Ft, of First Floor: Cost of Construction: $ .2 Utilities: Sewer �Septie Building Heig ht: Name L (-,(. Address:_/ City: State: /::C - Zip Code: _-4 S 7 Fax: Phone No. E-Maii:Cao 7— :� C orrA r cam. l�`) 'C� fn L c o> Fill in fee simple Title Holder on next page ( if different from the Owner listed above) CCSNTROR Name: E Company: Address: t" , City: U-- State: [� �- Zip Code: c- -T— 3 Fax: Phone No. -Yl 2 . c ,� ` `-f k- 3--- State or County License: C_ c- 4 - If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. ;4L CONSTRUr-rin LIEN i A A, I N: EER: Name: �– Applicable Address: City: State: Zip: Phone FEE SIMPLE TITLE HOLDER: Not Applicable Name: Address: City - Zip: Phone: r.�.nainn�lCA MORTGAGE COMPANY: Not Applicable Name: Address: City: State: Zip: Phone: BONDING COMPANY: Not Applicable Name: – Address: City: 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. that is which is inoca tuft with any applii`cableiHo a Owners Asssociting a ation rulesrmit will abylaws outhorizer and covenanthe perm t s that maybuild restrict ojrprohib t 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 I d commencingwork or recordingour Notice of Commencement. en mer or an attorney before [tig�nature of Owner/ Lessee/Contractor as Agent for Owner Signatu of Contractor/License Holder STATE OF FLORIDA r COUNTY OF /` �— STATE OF FLORIDA s , G COUNTY OF -) The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this��daey of cr 201!� by this.;LS day of 20-Lby 'T�=l IL V — Name of person making statement L--2 Name of person making statement Personally Known OR Produced identification Type of Identification Personally Known OR Produced Identification Type of identification Produced_ /? _ 4 Produced (Signature of Notary Public- State of Florida {Signature of Notary Pub''c- State of Florida Commission No. -2- ryS 1 (Seal) Commission No. L 6 ; F � 'X (Seal) REVIEWS FRONT SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW FREVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17 TAYLOR GAGNE; Notary Public -State of Florida TAYLOR GAGNE Notary Public -State of Florida Commission # GG 293167 r,umrrlssion ExpiresJi 'F�uEn+�`�01 M January 21, 2023 [[[ _Y_ January 21, 202