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HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: (17 'D .ia• - Permit Number: �I®J ' dz:� ci„ef)S RECEIVED Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 MAY 12 2011 F.;rmittvng Dapartmanr 5c. Lucie _ount•,' Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line 'PROFOS'ED I'MPROVEIVIENT LOCATION: -= Address: /V Legal Description: laf/6_14 AO Property TaxlD#: 56q 04Qy--QQV1 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: �iE7A%%(1!'-e °�'�✓'���c� �� /.�/Ud�f. ��°/y��-�1�.�2��j%��lj;� ��S•� ' GOIVSTRU"CTION.IAdd .NFORMATIO:N;: itiona work to be er or•me under this permit- check all apply: �HVAC Gas Tank ❑Gas Piping Shutters- ❑Windows/Doors Electric 0 Plumbing MGenerator Sprinklers L' I Roof � Roof pitch Total Sq. Ft of Construction: S . Ft. of First Floor: Cost of Construction: $ 3b0 Utilities: Sewer 1:1Septic Building Height: `=01I1fNER•/LESSEE: CONTRACTOR: • Name e /`2. Name: 0 jP% G GLl t Address: 17,66 All/ • City: �✓��<<'�C State: � Zip Code: Fax: Phone No. 9' 72 — 2 ,q 2-—% . < 0I E-Mail: Company: ,e_ Address: 03 City: !."� Zip Code: Phone No. E-Mail: oJW,S" State: Gc� Fax: 772'��L� lig�y Fill in fee simple Title Holder on next page (if different State or County License: zVL'•l`1 05-7O,6` from the Owner listed above) �� „a�..= W� UW11*L1 UUUL11 1 15 �­auu ulr mere, a ncwrcuev rvotice or commencement is required. i SUPPLEMIENTAL CONSTRUCTION LIEN: LAW, 4NFO;RMATIAN.; 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 Name: Address: City: Zip: Phone: BONDING COMPANY: ,Not Applicable Name:_ Address: City:_ - 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 jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attorney before commencing work or recording vour Notice of Commencement. Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA uc�41 STATE OF FLORID �� COUNTY OF 5' COUNTY OF Vic The f r oing instrument was acknowledged before me this ay of v 20��by The f ing instrumenwas acknowledged before me this ay of 207) by 11 �© —� Name of perso making statement Name of per1gh making statement 7i Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced 41111111( (V ° ° otary Pu II •State of Florida (Signat e� =N�y o miEx a ida ) r " •..: RICHARD WELKER Commis °�$� S � `: Notary Public -State of Flo�� Bonded through National Notary Assn. CO (Seal) �o ommis"Bi G 90957 F �•' My Comm. Expires, Sep 2, 2023 Bonded through National Notary Assn. REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17