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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: Z� 3 2 0 aG Building''Permit Application Planning and Development Services Building and Code Regulation Division . 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial -Residential 'PERMIT APPLICATION FOR: PROROSED IR r,ME�EME T LOCA ION: Address: /- 'O Legal Description: X 6/ QQ /4n.c)�/, /66 X—w E� ^/ l�2 "I so 1- ( 1-- 0116-Dbl to Property Tax ID#: Lot No. v�0 Site Plan Name: ,ty P Block No.fl?�-6 Project Name: Setbacks Front Back: Right Side: Left Side: . OETA LED DENS*R�IPTION ©F WORK: /610 ' �v tS, � %� rX,��l' Feo%,-: / S �a2 - 3wo OtT ps,i �( y s61 eel c,� _ . . - C®NSTRUCTIO INF©RMATIO Add itiona I work to be performed under this permlit—checT<all that apply: _Mechanical =Gas Tank _Gas Piping. _Shutters . Windows/Doors Electric _Plumbing _Sprinklers _Generator Roof Pitch' Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ ��� Utilities: _Sewer _Septic Building Height: CIWNER/LIPSRRE-1 CONTRAC GR: N(de 2cS ��� Name: i L A ����S/ �p_ A-t> Company: Q Ac C �`f' ��{'l Q� State. Address: 8- P6 /��c PQ j l� `e i2< Zip : �C17 ( Fax: City: A cl"-,e T749 State: Po. Zip Code: Fax: Fax: E Phone No 7)ZJS7?—L�?/ Fi simple Title Holder on next page(if different E-Mail tt6S _ (,frOwner listed above) State or County License 3 A �Cj If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. PRYMPNOT,NTAL CON�ST +tJCTION 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 commencin work or recordi u N ice of Commencement. 777 Signature wner/Lessee ont act as gent for Owner S nature o ontractor se , Ider STATE OF FLORIDA STATE OF FLORIDA COUNTY OF L(,LG("e COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this��day of '—kQi 20-,by this day of 20_ by �5 �Q (Name of person acknowledge g) (Name of person acknowledging) (Signature of Notary Pub -State offlorida) (Signature of Notary Public-State of Florida) Personally Know P uced Identification Personally Known OR Produced Identification Type of Identifica 'op;PRYP�a, ELLEN V Type of Identification �_° _state of AUGHN Produced Produced _ - a-Notary Public ;9 or ommission # 0G 270 - P o7s (Seal) o,� �,. MY COmml s'OaTxpires Commission No. Commission No. �--.. _ REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE- MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.