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HomeMy WebLinkAboutBuilding Permit Application' All APPLICABLE INFO MUST BE COMPLL% FOR APPLICATION TO BE ACCEPTED 6 q7 . • Permit Number: t Date,,�..0� r� 91R0%+i - 1 - - 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: Wk aw PR©P0- ED INPRtJUEMEN �OCAT'IQN: Address:l Legal Description: Property Tax ID #. •, �• - �""`-� G to r Ly_�_ Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: ;Left Side: D Af'LE® DE�SCRd'PTION OF WOR CQNS*T`R}lJ TI®N 11NFORM TtON: Additional work to be pertormed under this permit —check al,,l that apply: _Mechanical _ Gas Tank _ Gas Piping _ Shutters Y'__ Windo s/Doors _ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $�'J ' Utilities: _ Sewer _ Septic Building Height: OUI/N�ERLE-SEE: CC+�'N RAC OR: Name Co•mparyt�`"`�' Addre �� City:w1V State: L Address: - {! Zip Code: Fax: City: State: Phone No. ,> Zip Code: Fax: E-Mail: _ : ' Phone No Fill in fee sim le_Tit� lEK6_jder on° next page f 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. SU 610".0, � A M"twIs °RIIC 11, INN LA. VAI, DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: City: I State: Zip: Phone • Zip: I Phone: I FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING OMPANY: Not Applicable Name: Name: Address: City: Address: City: Zip: I Phone: i Zip: Phone: OWNER/ CONTRACTOR.AFFIDVIT: Application is hereby made to obtain a I certify that no work or installation has commenced prior to the issuance,of a pE it to do the work and installation as indicated. 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 J in accordance with the approved plans, the Florida Building Codes and St. Lucie Co' The following building permit applications are exempt from undergoing a full cone accessory structures, swimming pools, fences, walls, signs, screen rooms and acc'e! WARNING TO OWNER: Your failure to Record a Notice of CommencemE improvements to your property. A Notice of Commencement must b before the first inspection. If you intend btain financing, consult compiencing wl or recording your r4l Of Commencement. ill, in all respects, perform the work my Amendments. rrency review: room additions, lory uses to another non-residential use It may result in your paying twice for recorded and posted on the jobsite th lender or an attorney before Si nature of Owner/ Lesse / gent Signature of Contractor/License Holder STATE OF�Fl_ STATE OF FLORIDA COUNTY OF COUNTY OF The f going instr ent' s acknowledged -2(�E before me I The forgoing instrument was acknowledged before me this day of by this day of I 20_ by (Name of person acknowledging) (Name of person lacknowledging) 1 (Signature of Notary Public- State of Florida) 1 (Signature of Notary Public- State of Florida ) Personally Known OR. Pr d c p�* Mtto i E erson ly Known OR Produced Identification T dentification Type of Idle i tca ion �u kips,, i<,•. NadryPntilk-St�teotiNB�1� d Produced ,,•` co". M r �f�b1Q 3. . • s My �r N EE 877571 ' Commission No. �'��� �p�nission 8ondedThrough Natior•.a' 4fw14W ion No. I , ($e�i)' I REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.