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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 Date: f'� OZ Permit Number: I l C 05 U10 Building Permit Application Planning and Develo mentServices Building and Cod Regu ation Division 2300 Virginia Avenu` ort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line c h3Y�vi Y c iy 3atr � y .� r N�w6xF��'�-� Address: S , �uGG�� !U C l -.� _. ..-�Y fG�� Legal Description: [7�t� ►`��/l� �p c7� ,S'/l0 �� abL Property Tax I D#: A 7 216 '67Gv2- ©�5� —D f C7/� Lot No. Site Plan Name: Block No. Project Name: /if �),02M Setbacks Front Back: Right Side: Left Side: :.� r a c�' -�� ����_ �-'� Jti-,fb�r4t�� �--li--a 3"-�'K--,L'. ems" -§�'-• ws : � r Additional wort to be ertormed under this permit-check affapply: L]HVAC Gas Tank ❑Gas Piping utters Windows Q /Doors Electric Plumbing Sprinklers Ilenerator Roof Roof pitch Total Sq. Ft of Construction: S 11 of First Floor: Cost of Construction:$ ?f 0'.P '0 Utilities: Sewer Septic Building Height: Name l�ll✓' ll ��GSl� e Name: D e" Address: 2 2 O �G �� u Company: State: L Address: 2, U3 1 Svc Zip Code: ,����` Fax: City: State: r/_ Phone N - U- o. 7�.Z _�, ! / 19 Zip Code: Fax: 722- ?d/-f.24Vd"2 E-Mail• Phone No. —2U Fill in fee simple Title Holder on next page(if different E-Mail:__ �'�Id 11, Av eS L:�D from the Owner listed above) State or County License: OXC DG S 4 If value of construction is$2500 or more,a RECORDED.Notice of Commencement isuired. 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: 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 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 our Notice of Commencement. k'6c<� Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF %_ NS P, The forgoing instrum nt was acknowledged before me The forgoing instr ment was acknowledg d before me this��day of 20�Nby this�day of 20� by Name of person making statement Name of person making statement Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Prod ced Pro ced N. 10 (Sig to a of Notary Public tate of Florida) to a of Notary Public- te.of Florida) Commission No. .RAHMING Commission No. sia'f........ LAS RAHMING yyiroii;.,% LASHAIWAI G 215060 MYC�GG275M m(COMMISSIceN 20,Z022o oQP`..' SIRES:December 20,2022 • .e l:•• Bonded Thru Notary Public UrxleNlterc Thru Notary U REVIEWS VISOR PLANS VEGETATION SEA TURTLE MANGROVE C NTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.8/2/17