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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE.COMP-LETED FOR APPLICATION TORE ACCEPTED Date:, � ..Permit Number: ad a 'd3 RSC _ . ... .a®,. : Building-Permit-.Applicatio �cn9pe 4g� Pan Planning and Development Services - e�r�fiy ent Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phonee(772)462-1553 Fax: (772)462-1578 Commercial Residential PERIVfIT TYPE PRQP45ED IIVIPROVEMENTSLOCATION '�'-� � ` - ,a> ,°"- n. Address. (D9 PropertyTax,IR:#: :;�5//— �/S OQ O 9-:D bo.- Lot No. ..: Site Plan Name: Block No. .3 Project Name: . .w �A r Additional work to be performed under-this permit—che&rall that apply:., _Mechanical _Gas Tank _Gas Piping _ShuttersWindows/Doors _.Electric Plumbing Sprinklers : :,.... _Generator..- Roof _. Pitch Total Sq. Ft of Construction: Sq. Ft.of First Floor: d Cost of Construction $ ©o Utilities: _Sewer Septic Building Height OWNEk LESSEE: � � �� z r� i z CONTRACTOR �r ..,.i� ��'_,„.. ..v,✓ry 4'�._Lr..,. ..0 �”�c?�..- ,.�f �?t ._ �'�- {x - 5 rr> "Name Name: ;Address: Company:55 City: n„ _ j r r,/. State:JG Addre s:163aGJ!/�� -2S . Zip Codej 1126- 7 Fax: City: � l,Gt�2� State: 'Phone-No:77ol- as 9^-a 609 Zip-Code: 3XL�7 Fax:- E-Mail. Phone No -M c26:3=.3 31hO Fill m-fee.simple.Title.Holder.on next:page(if.different E-MaiI,�QGTij?/►C $y�� from the Owner listed above) - 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. s ' SUPPLEMENTAL CONSTRUCTION LFEN�LAW I[VFORNIATIOftI '£ fy 2r 3 DESIGNER/ENGINEER: Not-Applicable -MORTGAGE COMPANY: =Not-Applicable - Name: ) Name: A) A 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. 1 certify-that no work or,itistallation has commenced`prior to the issuance-of a p'ermt, ; St Lucie'County makes no representation'that is granting a permit well authorize'the permit holder to build the subject'structu:re' 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,_)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 RECORDA NOTICE OF COMMENCEMENT MAY RESULT IN YOUR.PAYING TWICE-.FOR 1MPROVEMENTS.TO. YOUR'PROPERTY.'A"NOTICE OF COMMENCEMENT MUST BE;'RECORDED-AND POSTED ON-THE'JOB'SITE'%BEFORE-THE`FIR5T-INSPCCTION:-IF YOU INTEND TO-OBTAIN-FINANCING, CONSULT WITH YOUR LENDER OR AN. ATTORNEY BEFORE RECO.RDING YOUR NOTICE.OF_COMMENCEMENT.'.'. .. . .-. Signature of CWherl Lessee/Contractor as Agent for Owner Signature of'Contractor/License Holder ;STATE OF FLORID STATE OF FLORIDA COUNTY OF— 'The COUNTY OF The forgoing instrument was acknowledged before me Thef r oing'instru was acknowled before"me " :this 4 day of . J'E.ISVuV� —1 20 , by this day of " 20 by Name of person making statement. ,Name of person making�st tement. � 'Personally Known OR Produced Identcation 'Personally Known ORProduced Identification, Type of Identification Type of Identification_ ..Produced. .. -�'I.._.__ � Produced . :_ __ _.. _ �d (Signature of Notary Public-State of Florida) Signatureo_ Notary_Public-Sta of Florida Commission No. r.'� IublicState 9Florida mmission N o`'"Y�� ;SHER_ ELLEY / eal) Llsa A Galvin n#FF 99929 • •, M Commission GG 198680 y _ Expires October4;2020 • tionai .: REVIEWS FRONT ZONING P -R SO LANS V SEATURTLE MANGROVE COUNTER REVIEW REVIEW- REVIEW.. REVIEW REVIEW, REVIEW, DATE RECEIVED DATE CO M P LETED