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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE CO' -;,ET' OR APPLICATION TO BE ACCEPTE', i Date: �`\ 1�1 Permit Number: L�OI 83! 0A1333H 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: Address: U J{a210�- -'B%vc,L FP3 L/9 D Legal Description: 1 L�,9&l �3 �1 ,fir. rti��c S / A4 Property Tax ID#: 3410Z"' 6109--4M " ©OO" Lot No. J Site Plan Name:,�9��,y1�s3.s's� - S'009ef— Block No. S3 Project Name,-Pe /Y�igsgF� S0.7 9;�_A Setbacks Front Back:Z? _Right Side:I Left Side: U Additional work to be pe Orme under this permit-c ec all t at app y: _Mechanical _Gas Tank —Gas Piping —Shutters 'Windows/Doors . JCElectric �K Plumbing _Sprinklers _Generator Roof Total Sq. Ft of Construction: Sq. Ft.of First Floor: `7= l g Cost of Construction:$ �� Q, 000 Utilities: _SewerSeptic Building Height: Name 0#A0, IVAf leS_1 Address: D o ✓rS ::�: `'Cbrii an ' 1 p I+ I ;nduy vi.. . �.r a City: e et.SJc I&eyY_ Stats pis' ;-AddresK a._), Zip Code: Fax: �i`iji.gym;.. ,.;;.:;• State: Phone No. 72-Z -y e5"Q 1 S 6 Zip Code: Fax: 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. DESIGNER/ENGINEER: >4 Not Applicable MORTGAGE COMPANY: of Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone: Zip: Phone: FEE SIMPLE TITLE HOLDER: t1 Not Applicable BONDING COMPANY: _, of 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. Lcertify.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/Agent/ essee Signature of Contractor/License Holder STATE OF FLORIDA.- ` i' STATE OF FLORIDA COUNTY OF 13T COUNTY OF The f Y nst wa ck wledgA before me The forgoing instrument was acknowledged before me this a of 20 b this day of ;20� by 1�. t�C�sse (Name of person acknowledging)" (Name of person acknowledging) (Sin ture of Notary Public State of Florida} (Signature of Notary Public-State of Florida) Personally Known OR Prod sed! le `kation V/ Personally Knowd OR Produced Identification Type of Identification Produced of Identification Produced Commission No D1�3 Seal AAIEILA P HA J ��iss n No. { Notary Public-St tt Of Florida REVIEWS FRONT Z I "n ' I�SU�� daPM? VEGETATION SEA TURTLE MANGROVE COUNTE.ft R REVIEW REVIEW REVIEW DATE `> RECEIVED abil DATE COMPLETED Rev.