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HomeMy WebLinkAboutBuilding Permit Application .11 Ut7V 1 V GV V I.CUFJ � PA All''APPLKABLE;iNF0 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: r i i Building Permit Application 'PlanningDevelopment an d Services Building and Code Regulation Division i 2300 Virginia Avenue,Fort Pierce FL 34982 / Phone:(772)462-1553 Fax:.(772)462-1578 Commercial Residential i PERMIT TYPE: Address:2 ( Ca ^� Property Tax ID M ��1 -I '� ©�— Q 7 --�© � --� Lot No. � Site Plan game: Block No. G] Project Name: IY t Additional work to be performed under this permit—check all that apply: _Mechanical _Gas Tank _Gas Riping Shutters _,/WihdowsfF]oors Electric —Plumbing _Sprinklers ^Generator _Roof Pitch Total Sq. Ft of Construction: Sq.Ft.of First Floor: Cost of Construction:$ OW Utilities: _Sewer Septic Building Height: Name c Name' h Addre.S --- S h. cin Company: Y r I C� ..1ty. r-0c State: Address Zip Code: 5 Fax`_ City: State: r Phone No ` Zip Code: 9!- _f 9� 3 Fax: E-Mail: Phone No _ ,.!!.in fee simple'(itle Holder on neii.Wage if different E-Mail ,. d 'he Owner listed above) State or County License02 0 _ N:ction is$2500 or more,a.'i „ .500 or more,a RECORL'ORDED Notice of Commencement is.required. Notice of Commencement is required. _ I ,I p.1 Dec 15 20,02:53p 03S7 . �� ,l 7 . DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: Address: Address: I City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _blot Applicable Name: Name: I� Address: Address: I City: City: !I Zip: Phone: Zip; Phone: OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the.work and installation as indicated. 1 eertify Ehat no"work or installation has commenced prior to the issuance of a permit. St.Lucie County makes no representation that is granting a permit wiil 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 'M ARV[ TO RYNER:yYORUR [ES TILURE O RECORD A NOCIECE'l OFfi iM Rp OR MEE TES p yOUR pRpPE TY O E F OM E W B F�EC QD AND POSTEDON fi !OUR �,C�jR � a� �T� B '"t�0 � F �gg� INSPECTION. IF YOuu I TEND TO OBTA N FIN C T S LENpER Ohl A. AT ORNEY BEFORE RECNORDINd YOURTNOT CEOUF COIVI ENCENIENT.," NOTICE O Sig ie o Owner/Lessee/aMtfactoras Agent for Owner Sign at ontractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF �c� 1,,c,t COUNTY.OF 7:- The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this-�day of 20� by this_ day of =12 20�;by / roJ� Name of person making statement. Name of person making statement. Personally Known OR Produced Identifi 4 Personally Known OR Produced Identification Type of Identification �,00�a6l�i �1•�j�r�� Type of identification Produced �t ��,ii P�(�42 GO.;,�E2���'�i� Produced 1C—c NFL�yee»t4li:illl;r��rl, ,� �••n,�.Ss1CNErop•. �� �e���¢��ER GO,,,��,!/�, ICY Era n\ .p 1 c�LP (Signature of Notary P lic-St to aft) rda) •2 #Gcs2ssa5 ; (Signature of Notary Public-Rite of 9•o*ida r�0• d E°tided�bt�y:�;•G2•,� � •• ?tC:G°^<654� ^y:�ti. Commission N0. ��IoS�S �f a pLulicU�o°. ����' Commission No. G.G1R a�� ��°r�ii. ffi�fi/j,U`R��r'C,•SI H1�Q+\`�`. � �4.YpL!lic Under••�l�v�v / \�� ✓�, f p, tic ,dam NNO REVIEWS FRONT ZONING ' SUPERVISOR ` PLANS VEGETATION SEA TURTLE MANMVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED � II II