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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED.FOR APPLICATION TO,BE ACCEPTED Date: Permit Number: 10 Building Permit Application ��<�`'' 'Ilse Planning and Development Services �P eAa Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 .Fax: (772)462-1578 Commercial Residential PERMIT TYPE: — eP6 J Ole& Fed ' eff. P t1P��� D •CAT M T 4.�. 'Address: p y ;� r7�/ (Property Tax ID#: `7 U Q 10 7S '6a /,0f — Z-)OZ)— Lot No. i Site Plan Name: Block No. 'Project Name: j m TAi'L t7MORI J TI N F 9 W MER cry- hE /n ' � TRU T! tIP4R IQN: 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.'• .P,itch i Total Sq. Ft of Construction: yd Sq. Ft. of First Floor: ,Cost of Construction:$ .Utilities: —Sewer —Septic Building Height: W �RjS -,E C(JNTRAGT•R: Name a S Name: i - Address:a/nloa v P Company: ' city: p��P,'�Q�'C:' State: Address: Zip Cocle.2 Fax: City: State: Phone No. —? 7 '" =-7 Zip Code: . . Fax: E-Mail: Phone No Fill in fee simple Title Holder on next page(if different E-Mail j from the Owner listed above). State or County License f If value of construction is$2500 or,more,a RECORDED Notice of Commencement is required. 1f value of HVAC is'$7,500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTI©N LIEN LAW INF©RMATIO'N: 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 AF.FIDVIT: 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." /�/,(a2lhe�2� Si nature of Ow Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF sk wQe, COUNTY OF The forgoing instr acknowledged before me The forgoing instrument was acknowledged before me this�day of n was ac 20�D by this day of 20_ by Ok 1,0 n n 01l hks Name cf'person making statement. Name of person making statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of IdentificatioA Type of Identification Produced �--L Produced (S' na re of Notary Public-St of Florida) (Signature of Notary Public-State of Florida) ... ..A.'.BM�••..•�".".wYl'aSM1Ci7K21kSd1iE3 LASHA.HNAING HMING Commission No. „,: Commission No. (Seal) * i MISSlo G 275060 Q ,: ., c EXPIRES:December$0,2022 Owdo Thru Notary Public Ul Iderwri rs REVIEWS ( G SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.