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HomeMy WebLinkAboutPERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR: Address: 5& `,__� Legal Description: Building Permit Application Commercial Residential_ Property Tax ID#: cc q I 6(�C) Lot No.� Site Plan Name: \,)(,)�Yi ±,, j Q Block No. Project Name: M b,' I N l �) Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF O K- -- C-1 V1 fir ;, .fn-) n cC NSTRIJCTiON INFORMATION: Additional work to a pertormeal under this permit — clieck all tat apply: _Mechanical Gas Tank _Gas Piping _Shutters _ Windows/Doors _ Electric V/ Plumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction: Cost of Construction: $ Sq. Ft. of First Floor: Utilities: —Sewer —Septic Building Height: ?LEST= •,. CONTRACTOR: Name j �.� } Name: Addr Company: City: "�J *e`Address: Zip Code: Fax: Cit Stat ;--e Phone No.--? ..1 'a, `a) [� ( �'� "16 — Zip Code:34Q?, `c, Fax: E-Mail: Phone No % `c CL(n 15� nz. Q Fill in fee simple Title Holder on next page ( if different E-Mail from the Owner listed above) State or County License If v�lnn .�F .... +.....a:....:.. — — _ t -- - -- -- ---- - ..• _, - .._......r..,.... %, IV W �vIII loci GCF11" li 15 requireo. SUPPLEMENTAL CONSTRUCTION LIEN- LAW INFORMATION: 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: Applicable Name: _Not 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 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Signature of Owner/ Lessee/Contractor as Agent 9r Owner Signature of Contractor/License older STATE OF FLORIDA STATE OF FLORtD COUNTY OF �" I� ,l COUNTY OF J� �i I The forgoing instr ment was a s knowledged before me this day of i 20j by The forgoing instr nt was knowledggedlbefore me thisday of 2 by Name of person making statement. 7 Name of person making statement. Personally Known - - V_ OR Produced Identification Personally Known I/ OR Produced Identification Type of Identification Type of Identification Produced Produced (Signature oth6fa4rwyMby State of Florida (Signature of Not;0 u lic- St t of Florida ) Com S' '' " KARLEYMARIEGIESYNARNE ' ' fFloridE81) 101 Co "''© KARLEYMAAIEGIESYVARNdEa (Seal) ° • ' • Commission # GG 049801 t:Comm. Expires May t, 13.1 Wei � Ptibk State o$ Commission # GG 099801 '•.; �'OF it REVI ,. 'Bandedthrau Kato WaryP. 11bta Ass kndedthrouOlutia alWaryAssn. COUNTER G REVIEW SUPERVISOR REVIEW P REVIEW LE REVIEW REVIEW MANGROVE REVIEW DATE RECEIVED DATE __T COMPLETED ev.