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HomeMy WebLinkAboutBuilding Permit Applicaiton ALL APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: !V / Permit Number: r b V F -0 • Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 cot Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Address: W d ve ; \ r s / �� Ce 1652/ 3J/1,K7 Legal Description: Property Tax ID#: ,2 q 0-C- 201 01 y 00 d a 5- Lot No. Site Plan Name: Block No. Project Name: 04 Setbacks Front Back: Right Side: Left Side: Additional work toe nertormed under tispermit-check a appy: HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors Electric ElPlumbingSprinklers ❑Generator Roof Total Sq. Ft of Construction:9794 S Ft. of First Floor: c�J Cost of Construction:$ Utilities: _Sewer E]Septic Building Height: Name o l'?Jo "Name.: c_ 04�11a_l ���6^ Address:.Cc'OOd J .9✓e Company: C City: State:W Address: r Zip Code: 3 Vg tl City: "C�• ,yon e--C` State: 1 � Phone No. - J-z�' © � Zip Code: 7V9f t1.( Fax:7)1 E-Mail: I% �q Phone No. 7z- G/00 "q Fill in fee simple Title Holder on next page(if different E-Mail: X004 , 'CA U Li! c, y��a✓,�, Lly,�y from the Owner listed above) State or County License: cnc If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. DESIGNER ENGINEER: of Applicable MORTGAGE COMPANY: CNot Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone:. Zip: Phone: FEE SIMPLE TITLE HOLDER: ' Not Applicable BONDING COMPANY: �ot Applicable Name: Name: Address: Address: City: City: Zip: Phone: Zip: Phone: 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 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 commencin work or re4rcling your Notice of Commencement. S _Signature o Owner/Lessee/Agent ignature of Contractor/License Holder STATE OF COUNTY OF COUNTY �, ` � COUNTY OFSTATE OF ORlDA The for ging instrument was acknowledged before me The forgoing instrurpent was acknowledged before me this day of ��}r\� 20�by - tfiisay of � 20 by MC-L-5 Sy(�b 1 c (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Public-Ste a of Florida) (Signature of NAtafy Public-State Florida) Personally Known OR Produced!d Personally Kn OR Produced Identification Type of identification P .r- GHN". TAype of Identi a �lotarY `�opAp�a4, �1TGHN �4NY`RU l� of Florida- 007 �� ��State of Florida-N r . Commission No: .,'o~° .g`�=State s�0 27 Commission =* fubiic ._ nynrissi on ExAire,s- ;y a sion # rr 079 yi o, MY COyt114SS 202•l; '�i�orww°��` My Commission Expires 0o1ober 22 �'hu`� 'OC20b8f 22, 2022 f 4ti ,I Revised 07/15/ REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS