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HomeMy WebLinkAboutBuilding Permit ApplicationAOL All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED j r 1 Da1te: !^�� l i Permit Number: 1l �+ 0 IOC 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: IBM Address: 77 S � �t� � . ;� .. e, vim-.:_ 'l s ., 3 C/1 if-? _.p Legal Description: '��' -I�1 C. �`,4 � I.��f} �� 's (-:�l9 1�o Property Tax ID #: 3 %Z (9 02 © lb 0 Y Lot No. 2— Site Plan Name: Block No. 3Z Project Name: Setbacks Front. Back: Right Side: Left Side: o GO �oL— itiona -wor to _ ,e performed un , er t is permit— check all that apply: _Mechanical ' = _ Gas Tank Y _ Gas Piping - — _ Shutters _' Windows/Doors ._ _Electric ),P robing _ Sprinklers Generator; Roof Total Sq. Ft of Construc'tion,' ';I I't _ _ Sq. Ft. of First Floor: !. Cost of Construction: $ 7 �� '' Utilities: 'Sewer Septic Building Height: !` ` Name (�C �r © hu+� Name: 0,Y- o' Address: ! ll �G "4-y Company: R,2 ►"i^012 1pk)Y'bt44 City: ® S State:,Cl Address: 2 S GP-W Ik�— Zip Code: 3 YS Ir 3 Fax: City: n0 C State: �-- _ Phone No. Zip Code: `i� L/ Fax: E-Mail: Phone No. r7? 2 Fill in fee simple Title Holder on next page ( if different E-Mai from the Owner listed above) State or County License: 3 If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. DESIGNER/ENGINEER: ; _ Not Applicable Name: _ Address: City: Zip: Phone: State: FEE SIMPLE TITLE HOLDER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Address: City: State: Zip: Phone! 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. 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 alfull concurrency review: room additions, accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use WARNING TO WN : Your failure to Record a Notice of Commencement may result in your paying twice for improvement toy r property. A Notice of Commencement must be re ded and posted on the jobsite before the fi t in ion. If you intend to obtain financing, consult wit ender or an attorney before commencin wor recording your Notice of Commencement. .117 X Signat of ner Agent/ Lessee, Signatur o Contractor/License Holder STA OF FLORIDA STATE OF FLORI J COUNTY OF S-�� COUNTY OF The f ing instrument was acknowledg d efore .me The f¢�oing instrurnt w s cknowledge before me `-'1 lJ th' day of f){:-_ 20by this day of ; 201by �eF4— H(�J%P M:�KA (Name of person acknowledging) i (Name of person acknowledging) (Signature o otary Public- State of Florida) (Signature of N ry Public- State of Florida ) Personally Kno ram..,,... OR Produced Identifica ion h Type of Identifi ti Per onall Known'�1tq�ey:OR Pro cation I fica t0 osQced7Y H }P P p . R1201c r: 4. MY CCMNRSSION Commission Nog, C•" XPIRF 53 Bon HIRES: A ril ded Th p 2 Commission No. ryolaryPubl6' onde6 d 1 2 15 tiers Thra N, eA'n" N Public Underwriters REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Kev. //LU14