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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMT..�rED FOR APPLICATION TO BE ACCEPTEC -- /� Date: Permit Number: � % O 05 VrQn E, ® - Building; Permit Application sf4( �$F Planning and Development Services 410�0 Building and Code Regulation Division 0041 2300 Virginia Avenue, Fort Pierce FL 34982 yA� Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: Address: 2'3 ? Legal Description: Property Tax ID #: Site Plan Name: Project Name: Setbacks Front d;R I L4 011- U �;;DV-dDLOO) - oc3'q (P - o©I> - Back: Right Side: kerm e -ems►` s-h n 4 ' SAS z4c,-3r1 +. /1rv0 J'I c.L;,- fr JL 11 3 _ Left Side: Lot No. 19"' Block No. LP Aaaitional worK to ne pertormea unaer tnis permit- cnecK aii tnat apply: _Mechanical 'Gas Tank —Gas Piping _ Shutters _ Windows/Doors Electric _ Plumbin _ Sprinklers _ Generator -Roof Total Sq. Ft of Construction: " s Sq. Ft. of First Floor: Cost of Construction: $ M-7Q Utilities: —Sewer _Septic Building Height: i (7 `PI ®1N ERLEaS�SEE: COIVTRACT®R: Name Name: f' iRfYl P, -) Address: �CILA Company:" Address: TS M I City: Fc-�-r4- P•i P rCe _ State: k- Zip Code:15LI Ig Fax: Phone No. q r7.1..2 1 0&-P City: eofj s-}- L4A6 - - State: Zip Code: 3-q-q _ Fax: r r7)L-aor7 -r7!$ - Phone No E-Mail kto,i k -o-)-F, n o,z- , &oy- ) E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) State or County License li)2j oy LP If value of construction'is 2,500 or more, a RECORDED Notice of Commencement is required. �JPPL � EN �L CONS RU •� � � �� . � �; T.C4?RMA I+Q' 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 orprohibit such structure. Please consult with your Home Owner's 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 accessoryuses 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 vour Notice of Commencement. Signature o erf Lessee/Agent L JSigns r of C Sra`— ct /License Holder STATE OF COUNTY OF FLORIDA y COUNTSTATE OY OF ORIDA c� A The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this 93 day of O C( 201 by this day of Oe F— , 20� by 4A��� Q (Name of i5dr§dh ackno ledging) (Name of person ack o�wledging ) (Signature of Notary Public- State of Florida) (Signature of-Notar Public- State of Florida ) �Z�ORProclucecl Personally Known Identification Personally Kno F MY LX Type of Identification ;�: :: °' C®NST,ANBCE PRC?ULX Produced ' ' OMMISSION # FF 16051 Type of Identific COMMISSION # FF 160517 Produced °.h,••' EXPIR 3 ber 16, 2018 FbrMallotary� I ))�� ��• Commission No. ! U� �� �`•'%%Le e;a ember 16, 2018 1 L O 1 Commission No. l 753 Flor otaryServloe.com REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE. MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW 'REVIEW REVIEW DATE RECEIVED DATE COMPLETED Kev. //LU14