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HomeMy WebLinkAboutBuilding Permit Application I ' I All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: J1_ r � �YEeEIbFD �� JAN 0 8 2010 Building Permit;Applicatio"P, /wh Planning and Development Services fir'4Nse Part Building and Code Regulation Divisionhnp" 2300 Virginia Avenue,Fort Pierce R 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential _ PERMITTYPE: PROPOSED IMPR(+JUEME T LOCATION: Address: 3 7u7 ny � I � PropertyTax ID#: "7;yJ),5- lo20) (�5 - 007��� Lot No. Site Plan Name: Block No. Project Name: J EETAILED DmRtPTION OF WOR : 'I !i CONSTRUCTION I FORMATION: 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: cc�� Sq. Ft. of First Floor: Cost of Construction:$ A) '? ` Utilities:' _Sewer —Septic Building Height: ' I OWNER/LESSEE: CC��7,NiTiRACyT�O,R: Name Name: Address: D 7Coman ' P Y� flfl � City: PQll _. I G E Stater Address:_ Zip Code:3-[ L T"7 Fax: City:',,; State: Phone No. `Zip Code:!" " Fax: E-Mail: Phone Nol Fill in,fee simple Title Holder on next page(if different E=Mail from the Owner listed above) State or County License 'I 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 I I SUPP 000INTAL CCl'IYCTION LIEN LAW iNFORMATt©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 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Loud �9_nature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF _AA Q A _ COUNTY OF The forgoing instrurr&nt was acknowledged before me The forgoing instrument was acknowledged before me this_flay of 2011 by this day of 20_ by CA w I n Ubc (A- D Name of person making statement. Name of person making statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identific ion Type of Identification ProducedProduced (Signature of Notary Public-Stat (Signature of Notary Public-State of Florida) ``�a�tPRYpG�� Oi Commission No. =� 9 �� Commission No. (Seal) ra F Cornn F�Or a�q V °71 °n,�,G°tar !� REVIEWS FRONT ZONIN B , ooL S VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW qz2 re)3EV W REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.