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HomeMy WebLinkAboutBuilding Permit Application SUPPLEMEMTAL C©NST(3UCTI0 LIEN LAW INFORMATION: 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Signature of ner/Lessee/Contractor s Age fortOwn Signature of Contractor/License Holder STATE OF FLORIDA _ STATE OF FLORIDA COUNTY OF �' COUNTY OF The f rgoing instrument was acknowledge F art The forgoing instrument was acknowledged before me thiday of 20/ this day of 20_ by _4X OLS a c� Name of person aking statement. Name of person making statement. Qb Personally Known OR Produced Id Personally Known OR Produced Identification Type of Identification Type Type of Identification Produced :s . Produced — 1�)Z�tz&fo (Signature of Notaryublic-State of Florida ) (Signature of Notary Public-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 Rev. All APPLICABLE INFO INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Numb r / - r s ;pg . . t Hma`ii.f . ISI 0 W, APR 3 0 2099 Building Permit App I ition �ermitting Department _ Planning and Development Services �t, LUde I� �C U�t�i�, (=� Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT TYPE: 2.60 �7— V.i RX'111'6S@ I DI IMPR©UEMEN[T VOCKANDON: Address: 6� 0019-/ ��1 Property Tax ID#: r7 L?-? DO V o 0 C/G�-/1 Lot No. Site Plan Name: i Block No. Project Name: oly e, J7 Y-S. DETAILED DE�SC>�RI'PTION OE WORK: "VY, ',�- � eel Sl- i C 1z CONSTRUCTION INFOR+MATCON: Additional work to be performed under this permit-check all that apply: _Mechanical _Gas Tank _Gas Piping SNufte�s Windows/Doors Electric _Plumbing _Sprinklers Generator X Roof Pitch Total Sq. Ft of Construction: 66a Sq. Ft. of Fist Floor: Cost of Construction:$ I`I G L) Utilities: _Sewer "._'Septic Building Height: OWN' R AIEUSSEE: .CONTRACTOR: Name I('-S'(e it S wds Name: Address: 302 5, V3 rdV- Company: City: �1Qo-c� 2_ Stater Address: Zip Code: 31f 95"c.3 Fax: City: State: Phone No. `I72- -7-7-60 Zip Code: 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 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.