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HomeMy WebLinkAboutBuidling PermitALL 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 PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION: Address: /V1 it -rTE Legal Description: Property Tax ID #: Site Plan Name: Project Name: Setbacks Front Back: Right Side: DETAILED DESCRIPTION OF WORK: Revco u� �x►` T� Ng T->oqimaSQd --74 S— N e� gas a2/`v CONSTRUCTION INFORMATION: it�ona wor to [eer orme un er t is permit— c HVAC LJ Gas Tank Gas Piping lectric EJ Plumbing Sprinklers Lot No. Block No. Left Side: P/v Pe.de'gT-A f 140-woyq �ec�esry� j , allMutters ply: 1 Generator Total Sq. Ft of Construction: K © p Sq. Ft. of First Floor: _ Cost of Construction: $ Utilities: Sewer Septic OWNER/LESSEE: Name Address: /.' City: X. Q Fre- . 3 y q.57 Stater Zip Code: 39 9S- 7 Fax: Phone No. 8 YX' 5VQ E -Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) CONTRACTOR: Windows/Doors Roof a Roof pitch Building Height: Name: Company:tj Address: _ G�iC� s g� City; �fc�i9y2'r State., Zip Code: Fax_ Phone No. 7-:;a7 - cA37- A 3sJ E -Mail: -ZCw 140 Caoun � E �TYZeL . Cra State or County License: b iR y 9 c} 6 If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. t[]U N-117 Y 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 PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION: Address: /V1 it -rTE Legal Description: Property Tax ID #: Site Plan Name: Project Name: Setbacks Front Back: Right Side: DETAILED DESCRIPTION OF WORK: Revco u� �x►` T� Ng T->oqimaSQd --74 S— N e� gas a2/`v CONSTRUCTION INFORMATION: it�ona wor to [eer orme un er t is permit— c HVAC LJ Gas Tank Gas Piping lectric EJ Plumbing Sprinklers Lot No. Block No. Left Side: P/v Pe.de'gT-A f 140-woyq �ec�esry� j , allMutters ply: 1 Generator Total Sq. Ft of Construction: K © p Sq. Ft. of First Floor: _ Cost of Construction: $ Utilities: Sewer Septic OWNER/LESSEE: Name Address: /.' City: X. Q Fre- . 3 y q.57 Stater Zip Code: 39 9S- 7 Fax: Phone No. 8 YX' 5VQ E -Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) CONTRACTOR: Windows/Doors Roof a Roof pitch Building Height: Name: Company:tj Address: _ G�iC� s g� City; �fc�i9y2'r State., Zip Code: Fax_ Phone No. 7-:;a7 - cA37- A 3sJ E -Mail: -ZCw 140 Caoun � E �TYZeL . Cra State or County License: b iR y 9 c} 6 If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: Not Applicable Name: Address: City: State: lip: Phone FEE SIMPLE TITLE HOLDER: Not Applicable Name: Address: City: zip: Phone: MORTGAGE COMPANY: Name: Address: City: zip: Phone: BONDING COMPANY: Name:_ Address: City:_ Zip: Phone: Not Applicable State: _Not Applicable 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 recording our Notice of Commencement. Signature of Owner/ Lessee/Contractor as Agent for Owner STATE OF FLORIDA COUNTY OF The forgoing instrument was acknowledged before me this day of 20i by Name of person making statement Personally Known OR Produced Identification Type of Identification Produced (Signature of Notary Public- State of Florida ) Commission No. (Seal) REVIEWS FRONT ZONING COUNTER REVIEW I DATE RECEIVED DATE COMPLETED Rev. $/2/17 Halder STATE OF FLORIDA COUNTY OF 'rnct2 tiro The forgoing instrument was acknowled ed before me this ac) dayof 20 by f�r.ca L Name of person making statement Personally Known- 'X Produced Identification Type of Identification Produced 1�-- -, (Signature of Notary Commission No. '* :■ c°MMISia1 18121 ExPires Oct er , 2023 Bonded Tiuu Troy Fab k8urance 800.385.7419 UPERVIS � PLANS SANGRO REVIEWOR REVIEW � VREVEW©N � SREVIEW MREVIEWVE SUPPLEMENTAL CONSTRUCTION LIEN LAW 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: 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 jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attorney before commencing work or recording our Notice of Commencement. Signator-hof Owner/ Lessee ntractor as Agent for Owner Signet of C rector/ ' se Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF \ ', ^> COUNTY OF fyNC1,6z 'N Theforgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of JrL,� 2VC, by thisac�) day of 20_ by i�ci^o1 W I-) i i 4e lire, (2-0— 6', L-) I i 4e,k f6, Name of person making statement Name of person making statement Personally KnowtiOR Produced Identification Personally Known -_X OR Produced Identification Type of Identification Type of Identification Produced Produced - R f (Signature of Nota 4*PVP.i+ DANIELLE ZIELINSKI.'��..+.'.- (Signature of Notary P iC,, a .P ANI LLE ZI LINSKI Commission No. :*: 'Commission?j8121 Gommissiorf18124 Commission No. ' ;a'. Expires October 13, 2(123!0`' a Ex ires0ol er 2023 Banded tray Fain Insurance 80085 T018 a:fl Bonded Ttn Troy Fain Insurance 804-385 7019 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLF MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. $/2/17