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HomeMy WebLinkAboutBuilding Permit Application ChcCk1cash 1- no De All APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: Building Permit Application MAR NZO Planning and Development Services Building and Code Regulation Division S-1. Lurie County, ting 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462=1578 Commercial Residential- PERMIT TYPE: , RRO OSED )' ROUE�MENT C} 10 . Address: Property Tax ID#: -5cw,- D(oocq:�' Wo- 3 Lot No. Site Plan Name: Block No. Project Name: DE AFLED D��CR� PTION O OR�K: hri a\ co ',(-N s n. s - �es--aveir re8l 0 �4� c Y- CONSTR CTIO NFO A tON: Additional work to be performed under this permit-'check all that apply: _Mechanical - _Gas Tank _Gas Piping _Shutters %V1%inclows/Doors Electric _Plumbing _Sprinklers _Gen& tdr' % -1 'Roof F�/,.''° ''R'%tch —7` f :" Total.Sq. Ft of Construction: Sq. Ft, of First Floor: Cost of Construction:$; COQ - Utilities: _Sewer _Septic Building Height: OWNER/ ESSEE: CONTRACTOR. 'Name i © Z- Name: Address: le- Company: City: State:_ Address: Zip Code: Fax: City: State: Phone No. -111 .5 1'7 3 12 Zip Code Fax: 4 E-Mail: Phone.No - Fill in fee simple Title Holder on next page(if different E-Mail 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. t r J l 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." Sign IS o essee/Contractor as Agent for Owner Signature of Contractor/License'Holder TATE OF FLORIDA STATE OF FLORIDA COUNTY OF Lunt t COUNTY OF The for oing instrument was a knowledged before me The forgoing instrument was acknowledged before me this day of 20Zdby this day of 20_ by Name of person making statement. / Name of person making statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identifi ' n Type of Identification Produced Produced IVB ' (Signature of NoT"�Z• orida) (Signature of Notary Public-State of Florida) KAREN SIELSENCommission No. ° `:Stat of FIor Commission No. (Seal) ,= atary Pte` Commission # GG 207484 ovv�o�; My Commi June 12, 2 22 REVIEWS FRONT OR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.