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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: _1���� Permit Number: --�" Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce rL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 CoMrnorCial PERMIT TYPE: �L PROPOSED IMPROVEMENT LOCATION: Address: lO7.57 .z. Property Tax ID #: '-7 5// " , ?// - ['Y?-,- / Site Plan Name: Project Name: DETAILED DESCRIPTION OF WORK: 0 CONSTRUCTION INFORMATION: Additional work to be performed under this permit -check all that apply: ,Mechanical ^ Gas Tank _ Gas Piping p g )! Shutters Electric , Plumbing � Sprinklers ,_ Generator Total Sq. Ft of Construction: 5q. Ft. of First Floor: Cost of Construction. $ 1 L-' J 70. c� Utilities: —Sewer —Septic OWNERAESSEE: Name e a & Address: 10ZEI S, ©e.ea Del [ (� City: se' State: EL Zip Code:_� Fax: Phone No. o 3j y E-Mail: al Fill in fee simple Title Holder on next page ( if different from the Owner listed above) CONTRACTOR: Name:` Company: 40- r,` Residential Lot No. e -Z Block No. — Windows/Doors Roof `_ Pitch Building Height: City: I1 Sc an State: iC Zip Code: Fax: 7' 2 I-L4 3 C 4 Phone No � ` Cyr - E-Mail l v,rr�"ccr State or County Licens _ 3 ; nq If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. If value of NVAC is $7,500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: ++�.�wrcars��lY�7f111ttK: Not Applicable Name: Address; City: State: Zip: Phone FEE SIMPLE TITLE HOLDER: Not Applicable Name: Address: City: Zip: Phone: MORTGAGE COMPANY: Not Applicable Name: Address; City: State: Zip: Phone: BONDING COMPANY: —Not Applicable Name: Address: City: ZlP: _ Phone: OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that n�tjo( work or installation has commenced prior to the issuance of a permit. which is n conffictawth an* appicableiHomeaOwnerstAsssociati❑n rules,bylaws or and covenants that build drestrisubject t o� pstructure oh b t s ch structure. Please consult w Eh 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 an th o er 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 061-AIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA COUNTY OF The forgoing instrument was acknowledged before me this day of 20, by Name of person making statement. Personally Known OR Produced Identification Type of Identification Produced Notary Public- State of Florida } Commission No. (Seal) STATE OF FLORIDA - 000NTY OF , The forgoing instrument was acknowledged before me this 2Q li by /•'''dayof a� �Q Name of person making statement. ? `ea• ✓% Personally Known OR Produced identification Z �' Type of Identification Produced v E {Signature of Notary Public -state of Florida 2 Commission No. ' (Sea!) ;. REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW "ATE ECEIVED