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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c� Dalt t/�e: Permit Number: `"Losulb _ 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 TYPE: I PROPOSED IM�PR01/EMENT L©CAT1t�N: .. Address: 3 E AM— l A , I(Itexe,&aDAV t G,� 6 -3V9 fl CI Pro I pe rty Tax ID#: / ���• ®l(p� Cs Lot No. Site Plan Name: Block No. Project Name: ©ETAILED L►IE�SC*RIPTION(W WORK; co co Deoe-o_a I CC?NSTRUCTI N INFORMATION: I I 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 Total Sq. Ft of Construction: I Sq. Ft. of First Floor: p Cost of Construction:$ �'����n Utilities:' —Sewer _Septic Building Height: ©1NNER/LE�S�SEE; CONTRACTOR: ame y—'Z)YC— C-7VO C—X91V-2,41L2- Name: FCg7- Address: 270 ADC?^ /O �C 3o.�-� Z`S� c� Company; W5 50Z/S City: A Alllrce-A''S,al✓ ZS/g.0 State: /�Z Addr :7"4:'ess', :opt :G 7 .• Zip Code: g�°/ Fax: City,I �/r .s ,Q.. �- r9Y State: Phone No. 3O� 9� `� zip, `"'3 3©�D�` Fax 3�S" 0 E-Mail: LS0cvr m.� hone No 30 S ��9 0� l Fill in fee simple Title Holder on next page( if different E-Mail Ft--YI UST�S 6'�'�4i cmiLi (from the Owner listed above) State or County License /5c:"/2/,0;0' P00000ogg 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. S PPLEMENTAL U C«QNSTRUCTI N 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: I 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 I onsideration 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. Thi 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 N HE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH Y R NDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." I Signature of Owner/Less tractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY COUNTY OFOF �4 � d The forgoing instrument was acknowledged before me The forgoing instr ent was acknowledged before me this�day of �,A 2015 by this day,of 20a by IQ�p Name of person making stateme Name of person mak g statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Produced Type of Identification i Produced i ( gn ture of Notary Publi -State of Florida ) I-I - N h C-, ,, "I k�,�,')�,c (Signature of Notary Public-StAe of Florida Commission No. (Seal) � 'P ;,; IASHAHNA G -RAH,MING Commission No. :?•'' Comm, GG27OW a' EXPIRES:Decembeft 2022 %J.g.. .•oa;? REVIEWS FRONT, ZONING SUPERVISOR PLANS VEGETATION 'SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED I Rev 2/7/19 I I