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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �1 n /, Date: Permit Number: 19 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: Address: 10 cQ1 �! > G O Lek k)�� ?fJ� � s �1 �? k L.0 C ] a � -3 `17.� Property Tax ID #: 3�t 14 - S 0 l •1,7o ] -00o eJ Lot No. Site Plan Name: Block No. Project Name: 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: �� S Cost of Construction: $ 3 S Sq. Ft. of First Floor: Utilities: _Sewer _Septic Building Height: ©WN'ER/LE�S�SEE; CONT ACTOR: Name p i� ITU ) ► Name: z� S5, )Z 1 Address: 10 -T1J-D 160 t,/��J t✓ Company:AK-K'oi-'ki3L:E, A City: S L. _ State: L Zip Code: `'`� Fax. c� Phone No. 2 r! �l Address: .S S l� cJ y2r�1 i� is Cc (, City: S L Zip Code: �� �1 SQ Phone No QLA State: Fax: 60r;2 6 E-Mail: Fill in fee simple Title Holder on next page ( if different i from the Owner listed above) E-Mailqi',arAA blc-q %r re--o n 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. I KI 1 ESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable I ame: Name: ddress: 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 AFFIDAVIT: 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 mayrestrict 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 PR AN ATTORNEY BEFORE RECORDIN YOUR NOTICE OF COMMENCEMENT." Slgnatur . o�,Owner/ Lessee/Co ctor as Agent for Owner Signat e Co ctor/Licen er F\L)ORIDA STATE OF STATE O ORIDA COUNTY OF.�.a,��.� COUNTY OF LIC The forgoing instr nt as acknowledged before me �4 nu The for oing instrum wa acknowledged before me -0 this', day of , 20 1t by this day of 2011 by Name ol person making staterrYnt. Name of IS rson making stateme Personally Known OR Produced Identificat� Personally Known OR Produced Identification,' Type of Identification Type of Identification Produced Produced 1 (Signature of Notary Pu LASH AING M RAHMING g i nature of NoY �I�Cidi�Po�_RpHMING Commission No. :�: .*: MY C MM� SION # GG 275060 -'*: ., MY COMMISSION # GG 275060 Commission No. �'� Q° EXPIRES: Decenfaf9d)2022 :A ;e g�, ecember20,2022 EX a Bonded Thru Notary Public Underwriters on ThN Notary Public Underwriters 1 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED - DATE COMPLETED Rev.