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HomeMy WebLinkAboutBuilding Permit Application i I I, I 4 All APPLICABLE NFO MUST BE CO TED FOR APPLICATION TO BE ACCEPTED L/ 2 l �7 - Date: 1 Permit Number: Building Permit Application Planning and Development services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 I Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: PROP®SE//D INP'ROV R M Nk IN L®C NMI IO'N: Address: U�V ®e'en f (� Sf.411de F/, 3'W57 Legal Description: A e Plinem!r d#417,�'mI7 ,-!rllrrd an 1/0y i Property Tax ID#: G(O C) © � Lot No. Site Plan Name: Block No. Project Name: Setbacks Front ; Back: Right Side: Left Side: I DETAhLED 0,Eg Rag;IPTION6 OF WORK,: A �E11JDY(�Q�l�Ld IGfG(, C l l �d �e/7C� • �Ct'�/1 - !f elvzqUE 4�14 5hgwev 6P1erer mot` h n e1V W(J1k,q sh00-61-� CO STRIJCTtONI INFORal1/LATI'ON: Add itiona wor to a pe orme under this permit-check a that apply: ,Mechanical las Tank Gas Piping _Shutters Windows/Doors Electric lumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft.of First Floor:- - Cost of Construction: $ Utilities: —Sewer —Septic Building Height: 1 5 �:2?'s .al.�ora�;r,r;r»eefias{'ss:sf,^...i$n.elioa€3sr.«Y ®tIV DER LE-�S�SEE. @ONTR�AC�I QR: +Na'ine1 4j .IDhr :,.' 2QQyl'l'I '� Narrte -� „a-.i S id. ,:I.E^sr:, ..,. ,_,«. ^�• .: � � �- ^d� Lin• Address: SD Dc�car� p✓,' Company "A-Q _'12� #2kn'? 13'.'•,;�":,�,rcz,• -rN 1' aps "5 i _" .ir. )r .� .-i, � City: 2264,1 'Fil/%3 CIf Stater `_ Address: : 3 0�' .s `Ar ;'r u 1 s �- Zip Code: State:Fax: ` City_p e r e: Phone No. Zip Zip Code: �� 4 Fax: E-Mail: �7 37o- q-s-4 Fill in fee simple Title Holder on next page(if different E-Mail I ' from the Owner listed above) State or County License C SC VA 6 D If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. 5'UiP'PLEM+ENII�L C® STR+IJCTION LI'E�N LAW INiF®R!MJ�TIO''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. 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 tq 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 ork or recording our Notice of Commencement. Signa u e of Owner/Lessee/Contractor as Agent for Owner Si re of Contractor/1.ic se Holder STA E OF FLORIDA ,p ' l STATE OF FLORIDA COUNTY OF COUNTY OF j3(20UJ/g2 The forgoing instrume 9t was a <nowledged before me The forgoing instrument was acknowledged before me this_L nay of 201=7 by this / S day of FI12/Li L 20_L?by r7 FS/l,,/ %/S (NaMlson acknowledging) (Name of person acknowledging) (Signa ure of Notary Public-Stiffe of Florida) (Signature of Notary Public- tate of Florida) Personally Known OR Produced Identification �/ Personally Known Type of Identification Type of Identification ;;:�y°ge,,� `.,,,.. /� f10LD6ER R.COFER Produced �l4 n�'• SPON Tq (J � Produced F� ,D/L,,✓F 02 - i Notary Public-State of Flor d rMs Commiaelon#FF 89860 . Commission No. Se"°""• ( a�j/NTHIA TOOINO ommission No '%:Foac��:••t fpQ�Y�m.Expires Jul 13,2 1 Y P Osl�o� sae ;°= Notary Public-State of Florida •. •'= Ex Tres Sep 5,201 _ +r Com ission#FF 051760 REVIEWS FROM � `d LANS VEGETATION SEA TURTLE MANGROVE COUNT K R I W REVIEW REVIEW REVIEW REVIEW REVIEW DATE LA ! RECEIVED DATE Q,( COMPLETED_ JK� Rev. gl JC1A