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HomeMy WebLinkAboutBuilding Permit Application s tV `- i All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTE6-` Date: — Permit Number: 6 Ma. . _ .. 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: PROP®SED INPRMENT L®CATION: .p Address: �7 N 14114 I• c� //!S4&4Z_ Legal Description: 6oe� ✓J 4677 `'7 D PropertyTax'ID#: l q2 _ -7Q l _ f -7 70 /d Lot No. Site Plan Name: C C)LA91L Block No. Project Name: C Ugu Je!L. Setbacks Front Back: Right Side: Left Side: ®E�TAI�L.ED ®E�SCR�OPTION Of WORK: IrOSTy qt,( fu =i.J >9 Gam( !.J J1'V dye /Z o ?fT£b Wi1LLS . fU(,) S JA4,b 1r "- �� b"Qn, b Kf i� ( a-A-he . �,rqoVL �x�s Ism bEuc Ino C'O'NSTRUCTIO',N 2-M Additional itiona work to be performed under tis permit—check all that appy:, _Mechanical _Gas Tank _Gas Piping .:Shutters',", Windows/Doors' _Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ 2 Utilities: Sewer —Septic Building Height: OWN ER�S�SE� ; - � CO'NTRACTO! _ Name Iff C0LA C_ TM Name:• ' ° ' Address::�7 1. � I— Company: City:_�` T�( �Q� State: Address: Zip Code: Fax: City:, State: Phone No. �� Zip Code: Fax: E-Mail: a I'r.. W C z 6�.f% Phone No Fill in fee simple Title Holder on next page (if different E-Mail from the Owner listed above) Stat or County License If value of construction is 2500 or more,a RECORDED Notice of Cg mencement is required. 1 t SUPPLEMENTAL C«ONSTMMI R' LIEN LAW INF©'R+MATI®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�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. Inconsideration 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. a 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 FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The f r oing instrument was ackno ledged before me The forgoing instrument was acknowledged before me this day of V "4LN 20�-.by this day of 20_ by (Name of person acknowledging) (Name of person acknowledging) (Signafure of Notary Public-StAIW of Florida) (Signature of Notary Public-State of Florida) Personally Known OR,Produced Identification Personally Known OR Produced Identification Type of_Identification T pe of Identification Produced """ r d { RY PVB��i 1. ALANAH LOPEZ ., _ ,,,;;,..,• . $ Commission No. Notary Public-State f��Ph sion No: (Seal) , ?�f )wy Comm.Expires Ap 28,2017 . Yip+ OF�1�gp�' Commission#EE 669.52 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA,TURTLE • MANGROVE COUNTER REVIEW REVIEW REVIEW ' REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. /2014