Loading...
HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLE1)Cu'fOR APPLICATION TO BE ACCEPTED Date: R Permit Number: A��J d Ti SCEP"'D JAN ? D ::....o,..,,.,,...._.:..:.... .... ....w....,.�:.,_.m......v..� _...... 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: PROPOSED IN�P'R®VEI�LENT ©CATI +�'N: Address:G Legal Description: PropertyTax ID#: Lot No. Site Plan Name: at- Block No. cS0 Project Name: Setbacks Front Back: Right Side: Left Side: D T� I-LED DESS: +IPTION O' WORK: - - \,1 vim. Win. e��'a..(. R�A._ y C®IvSTR�UCTION INP0 1MANT,ILig"N: Additional work to be pe orme un er t is permit—check all that appy: —Mechanical —Gas Tank —Gas Piping —Shutters _Wi dows/Doors Electric Plumbing —Sprin lers JL/ Generator Roof - dwI6 Total Sq. Ft of Construction: y �A/0q. Ft.of First Floor: bh. Cost of Construction:$ � 0 Utilities: _Sewer —Septic Building Height: OW NSE /LE�5tiS ' CO N�'RAC'�TOfiR: NameName: . �r Address' -1,-Z 2 _L__2 J C eV' Company: City: �� fl - State:�� Address:t'o<�'c "`5 D`T c3"c�eV✓ Zip Code:, Fax: City: State Phone No. 7z7---1 60-0 2-0 '�� Zip Code:__%Qnf Jr I Fax: E-Mail: Phone No 2 '7 Z--qL?—C) 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. SCUP ° LEMENTAL CONST I�®N LILN LAW I`N ®R�IUTATI®'N; 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'6 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 Signature of Contractor/License Holder STATE OF FLORID STATE OF FLO COUNTY OF - • LtA e(,e-, COUNTY OF 1A The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this gydav of TA 020� by this v��day of 2-� �-% ,20 �7 by (Name of person acknowledging) (Name of person acknowledging) (Signat re of Notary'P l�ic-State of Florida) (Signa re of Notary b/lic-St a of Florida) Personally Known OR Produced Identification Personally Known ✓ O R Produced Identification Type of Identification Type of Identification Produced """ ,,.•• Ysi� GLYNNDOLYNHE13115 ,.•;�px:A�•, GLYNNDOLYN HEPWORTH Produced #FF 013115 _ 4 Commission#FF 013115 ` Expires July 16,2017 Commission No. ; QJrExpir �I 16,2017 Commission No. `% a ;'�' BondedThNTroyf�� 857019 Bonded gym/ sin Insurance 600.38.5-7019 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 112014