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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPL6tJ FOR APPLICATION TO BE ACCEPTED Date: \A Permit Number: RECEI''-.D JAM 2 3 7917 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:Lcs PRO'Og DI INP'RNSA EMEN INLO AT0ON: Address:T Legal Description: Property Tax ID#: �y�1r�dLi _c� Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DD rn MD ► �S IFPU iNO 0K: z7na s Xn// file F,4 b T� A pct' Z(,-` �c /© d = 1 r.6 J -- C�ON� ON F•RM Additionalwor to a pe ormed under this p6Fffiit–c_heck all that appy: _Mechanical _Gas Tank _Gas Piping —Shutters _Windows/Doors Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of.Construction:$ Utilities: _Sewer _Septic Building Height: 0 ER LSE. NCONT ACT Name _3A/z_6A Q ► tTJ 0 C l V/4 Name:_ zk� Ab ms's Address: Company: _, ' //a� �L Address: \'3V City: P 4 State•.•�i��e�- _ R Zip Code: 3q9 b',;2 Fax: City: F-4State: Phone No. 11 a– sd 1- y;sl Zip Code: Fax: E-Mail: Phone No 17'2-'2 ow/1, f '>Lf Fill in fee simple Title Holder on next page(if different E-Mail 62e9d'4' 'U MI. eLv/•e from the Owner listed above) State or County License t'_Q C_ 157't'57 S' If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. k i z i UPPLEMENTA C«O S" 11 1 MUMMY INF• MIATil— DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable Name: SCF }4'12 /' �Q—E9 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 recordingyour Notice of Commencement. 4 Signatu er/ / ontractor as Agent for Owner Sign t o C nt r icense Holder STATE OF FLORID STATE FLO A COUNTY OF �)-• L u COUNTY OF The forgoing instrument was acknowledge before me The forgoing instrument was acknowledged before me thisQ2:1.o day of ,20 by thisa3 day of Ja ,201 by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Pub' -State of Florida) (Signature of Notaryublic-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced L fl L Produced Commission No. � �(�0 1 (Seal) Commission No. 'GE'1 (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED 2 ev.