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HomeMy WebLinkAboutBuilding Permit Application'All APPLICABLE INFO MUST BE COMPLEII.�-OFOR APPLICATION TO BE ACCEPTED Date: Permit Number: ' 03Y.), 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: Address: &,019 S'F c,� _ Legal Description: Property Tax ID #: 3YZ n / • n003. 000 3 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: Mechanical _ Gas Tank _ Gas Piping —Shutters _ Windows/Doors Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction: Cost of Construction: $ _ Aov Sq. Ft. of First Floor: Utilities: —Sewer _Septic Building Height: OWNER/4IUSRP CON RACTOR: Name j6s�—, 14-c.yd✓fc2 Name: Z74&c4,42 Addres : ,60P S'&T , 1-42; 4L/ if('W-LL h/L Company: p4- Co,�e City: L Stater .0",6 Address:_(-�cgq Lam:• Zip Code: Ss;"? 3 Fax: City: R:1 Stater. Phone No.��'I 1,7,4 7 22-!V1 Zip Code: ? Fax: E-Mail: Phone Noc-6 Li z/aQ-�f4/1�t/ ,Fill in fee simple Title Holder on next page ( if different E-Mail S-(5—D A-0 from the Owner listed above) State or County LicenseL, 1, (23 0 8 if value of construction is 2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONST 10'N LIEN LAW INFORMATI©N. 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. Signature of Owner/ Lessee/ ontractor as Agent for owner. Signature of Contractor/Licens Holder STATE OF FLORIDA STATE OF FLORID V�' COUNTY OF cam. ����o COUNTY OF The forgoing instrurAent was acknowledged before me The forgoing instrumen as acknowledged before me this k% day of 20_n by this __n day of 20&_ by (Name of person acknowledging) (Name of person acknowled ng ) —Pdnature of Notary Public- Sta of Florida) (Sign a of lNotary Pu lic- State of rida ) Personally Known OR Produced Identification Personally Known OR Produced Identification Identification---. '`" �'LASHAHNAINGRAM Type of Identification yp Ty a of - -- -- Produced ._ - -=--------= LASHAHNA INGRAM o ��. Int. `y Public State of FlorOdommission Commission No.I =_ (Seal Dec 20. duced �� ;� n0.Y AUa (., _ .. is State of Florida ' ^�¢ G� ; My Comm. Ex�cpires PPec 20, 2018 No. .: Commisslxei�l9F 177249 Gmm. Expires 14 National Notary Assn. _ P. Commission # FF 17724 Bonded through '-� i� ''!qT `�✓Q"` 1 I Inr I - - .•-•. C fl11111�'pUIIUV:I lllluu a i:� �;` REVIEWS FRONT Ir`''ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW. REVIEW DATE RECEIVED , `DATE COMPLETED ev.