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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number- a cica Planning and Development Services Building and Code Regulation Division j 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR: Building Permit Application Commercial Residential x_ Address:.5132 Yane44, ZI a ff/ 6G�ec Fl -T!J> Legal. Description: T�, 4 17"o ve y J `_10e10 A0 roperty Tax ID,#: 3 y/0 -,To 7-0/5- 7 -0,00 - 9 Lot No. Site Plan Name: A4& Block No. Project Name: ©Les ky Setbacks Front Back: _ Right Side: Left Side: _Mechanical _Gas Tank _Gas Piping /Shutters _Windows/Doors _ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: of Construction: $ �1'ro o a 2 I Name t •o V'rg;N c. W! 01 Address: 5,93,2, A4,A &V l e Utilities: —Sewer —Septic City: 'rY, State: h t Zip Code: e/ f pL Fax: 1v Phone No. q E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) Name: Building Height: o Company: CocLf1Al Address: 2 i City: & . State:., Zip Code: ,3/-/9 Fax:7%2- V6/-6ZS.S Phone No 97.2 c/%l- a //,0 E-Mail ?p017, Tk4,, 7C ty I/aL1e0 Co/✓! r State or County License Cre_J3JIVS-,0J If value of construction is.2500 or more, a RECORDED Notice of Commencement is required. 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: 4Not 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. ignature of Owner Lessee/Contractor as Agent for Owner gnature of Con Tractor/License Holder STATE OF FLORIDA �t L STATE OF FLORIDA COUNTY OF COUNTY OF 6,91-La'l .e The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this r``iday of h/U'Ge, /� 20v20 by this �� day of If__bLlCc r/ . 20 2)0 by Name of person making statement. Name of person making statement. Personally Known OR Produced Identification Personally Known OR Produced Identification _ Type of Identi (cation Type of Identification Produced ProducedL SlaOgaOf01333foa 4 I �_ - - (112ro " _J /I __ C (Si ture of Nota - a (Signature of Noir lalin Srt�:tt�nf Gl K4 WANKO ��i Commission No.-- '_: .: Notary Pu �aof Florida �`1PRY PUB % - CARRIE-ELLE:QG - ♦ \\�qY PVI, Commission No. r2°, ;<<.% CARRIE-Et,liE_N�IANKO Commission 013829 My Comm. Expireul 20. 2020 ! _. ,ary.Public a e of Florida ommission # GG 013829 �llllll\\\ - REVIEWS FRONT ZONING.. '.SUPERVISOR PLANS VEG T TI A VE _ COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.