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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED j Date: D �� / Permit Number: ou - C) Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Y Phone: (772)1462-1553 Fax: (772) 462-1578. Commercial Residential PERMIT APPLICATION FOR:�.,� PROPOSED I PR0 4@M, iE A, ITW%CAT aN: Address: /0%,� JY J. 0<e4h & ,j?4", "�L• 3 %9S7 . Legal Description: 110h AV Ovd 4 f fl. Lvtie Property Tax IUD #: 5'////- 501- 90LI - 000- 4 Site Plan Name: fY0%i A�� Dvt Project Name: L Setbacks Froh't' Back: Right Side: Left Side: Additional work to be pertormed under this permit- check all tnat apply: Mechanical _ Gas Tank — Gas Piping. — Shutters . Lot No.? Block No. 14 Windows/Doors Electric — Plumbing _ Sprinklers — Generator _ Roof Pitch Total Sq. Ft of Construction: y3Q . Sq. Ft. of First Floor: 1/30 . Cost of Construction: $ /900,"a Utilities: Xsewer _Septic Building Height: Slf OWNER/LEaStiSEE: CONTRA ©R: Name n elm In Name: 4A r h n :Address::- =30% " '= /�: �/�• ' Company: ,� �i c / w�. % �C'• :Address , -=• � � /j/,L�... f/,Jlacl/• f�• City: =/ .'OCI,aP✓`, State:OH =!; - city,:.cTenyeh .goi LLeA: State: Az- Phorie No: - i Zip Code 3 `3y9S' % s 5 Fax:'77.2 ` 12 ��1 V , E-Mail:S Fill in fee simple Title Holder on next page ( if different E-Mail c A e" 5."Z h hC R V-4-X 06 - 5-0W State.or County License from the Owner listed above) If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. 5U'PPLEMENT L C®NSTR' CTI©N LIRN LAW N' 0 �ROVONI e DESIGNER/ENGINEER: Name: Address: City: Zip: Phone _ Not Applicable State: MORTGAGE COMPANY: _ Not Applicable Name: Address: City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: Name: Address: City: _ Not Applicable BONDING COMPANY: Not Applicable Name: Address: 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 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 commencing work or r cordin our tice of Commencement. 1 � . Signa ure o wner/ Lessee/Contractor. as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF �a9 COUNTY OF �{,sGs The forgoing instru ent was acknowledged before me this � day of 20� by The f going i s rument was acknowledge before me this /� dal of 20� by M J , (Name of person acknowledging) v.6 (Nam of person acknowledging ) tig N to o otary u -State of Florid J na ure of NotaryPu lic- tate of Florida ) rsonally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced Commission No. (Seal), Commission No. "`.��pYPU •., LASHAH IN RAM jjAHMING MY COMMISSION # GG 275060 REVIEWS FRONT r,• m. "�'%'.; �a 9`? EdOM 17Ri,E I g PLANS `'?•F VEGETATIO �: N ft� p li erwritars � COUNTE ervmtes EVIEW REVIEW' EVIEW REVIEW DATE - RECEIVED .. DATE COMPLETED Rev.7/2014