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HomeMy WebLinkAboutBuilding Permit ApplicationSUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION: 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: Nance: 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 ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." 5i-`-"_LL—p/rn�tractor as Agent for Owner j ignature ontractor/License Holder STATE OF FLOWDA STATE OF FLO, A COUNTY OF _ 1 m :OUNTY OF 4 rO The for Bing instrument was acknowledged before me 'he forging instrument was acknowledged before me this day of t 202a by :hiss day of 20 Z c by c5 � - Name of person makin statement. Name of person makim statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification _ Type of Idenf ication Produced Cc C :]�t Produced LAC _ v {Signature of Notary Public- ignature of Notary Public A WIMW& 6 OMO L DUMML Commission No.-- 3 jl me Of POWs ofPofda o&� ji �1i i6 flMGG22117•1 ammission Na. sion#6G221174 1 MY WIM. expires May 23, 2022 fly comm. expires May 23, 2022 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date Permit Number: 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 _ PERMITTYPE: P C PROPOSED IMPROVEMENT LOCATION: Address: ie- ?o 2.- Property Tax ID #: i 3Z, 7 - 7© - ©0'' 2- Cow -� Lot No. Site Plan Name: 4e '!1 /l^%-e-- qz,f M"dL 3oj P�J- SW�. '*bgfflock No. Project Name: I DETAILED DESCRIPTION OF WORK: I M. CONSTRUCTION INFORMATION: 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: Cost of Construction: $ 0 A.W' Clo Sq. Ft. of First Floor: Utilities: —Sewer —Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name_ S i02k t. k Name: Address: 35 I Lqkc �n 'Z Company: l� o!- r!y�� cjl,y 4r �. `, _ City: c rC - State: Address: 3:i� & iog Zip Code: 3�Ecj,5j Fax: City: 4414e Ate& Stater Phone No, 7'7Z-1�M-7 , 9 55!Z Zip Code:-3�--o.� Fax: Phone No 3{y i 5 (>g!4_ 7 E-Mail: 4y � l i pi p, C_b 1-L(-4Ac-e_ GoM1 Fill in fee simple Title Holder on next page ( if different E-Mail ryn.,4,ZS)hp from the Owner listed above) State or County License CAC: 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.