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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED. ` 2 c� Date: Permit Number: Ott ` O 3� S Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 r PERMIT APPLICATION FOR: Address: Legal Description: RECEIVED NOV 16,1021 Building Permit ApplicatioRrmiteing Department St. Lucie Count\ Commercial Residential Property Tax ID # � ©! 5 7 �h ` d a 6 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: .s CONSTRUCT ON IN�1=©RAM TI,O �� Additional work to be pertorme under this permit— check all that apply: _Mechanical _ Gas Tank _ Gas -Piping _ Shutters ,- Windows/Doors _ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction: Cost of Construction: Sq. Ft. of First Floor: Utilities: —Sewer _Septic Building Height: OWNER CONTR ("UR: Name. ,:d ' ;�� �: i°` Iri Name: rr Address:. - `L ° ,`: Company: doL'. City: r-CRState: Address:` e, Zip Code: Fax: City: e!-,L State: M Phone No Zip Code: a w�3 Fax: Phone No E-Mail e E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) State or County Lic se 124619 If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. - DESIGNER/ENGINEER: _ Not Applicable Name: Address: City: State: Zip: Phone MORTGAGE COMPANY: Name:' Address: City: Zip: Phone: _ Not Applicable I I' State:_ P FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: . BONDING COMPANY: Name: Address: City: _Not Applicable Address: City: Zip: Phone: Zip: Phone: II OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the wo° k 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 b ild the subject structure which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that m y 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, pe form 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: ro Ism additio s accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to anot`h r non-residential use WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in our paying twice for improvements to your property. A Notice of Commencement must be recorded and osted on the jobsite before the first inspection. If you intend to obtain financing, consult with lender or a ttorney before comnAcing work or recording our Notice of Commencement. e caner/ Lessee/Contractor as Agent for Owner §2 t o Contractor/License Hlol er STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The Y going inst u ent was ackno ledged before me this day of . 20_ by this day off 20 by (Name of person acknowledging) I (Name of person acknowledging )I (Signature of Notary Public- State of Florida) (' at re of Notary Public -State o Florida ) Personally Known OR Produced Identification Personally Known' -"Q)r Type of Identification Type of Identific ,,.P.,,,' LIW IN gr,G275060 Produced Produced : be00,2072 �? F.XP tkY pnMic tlndetvrtiten Commission No. (Seal) Commission No. %'. oil:•',, REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION ;I SE� URTLE, MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW �E, IEW REVIEW DATE RECEIVED DATE COMPLETED nuv. //LV14