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HomeMy WebLinkAboutBuilding Permit Applicationw ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: I b 11A.11,b 1-4 Permit Number: 11)0_ ®� RE Building Permit Application OCT 3 0 2-6�,7 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: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION: Address: 3?$1 5 225 51' , Fo+r P:e Ica. , � • 3401 S. I Legal Description: 29 3546 t7R.6e-- Sit ebf— Qf SEL 2z N S BS OEG I! r^t,J 30 Sft- W 40,13 ET -11" N O OC& OX eA%#J 3c > 6EG (N 26 rr -Vb ?OB ram// CAST N o o_:& Property Tax ID #: Lot No. Site Plan Name: Block No. Project Name: IP-f4 w c 11 &tr Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: 4,7'.+A6/ a•0"ui d47 u' all z,,j,4, wo��-. a�ar►ld oLc,u�y��. ZFT i/,14 CONSTRUCTION ,INFORMATION: Additional work to be nertormed under this permit— check all apply: 11HVAC Gas Tank ❑Gas Piping _ Shutters Windows/Doors 11 Electric 0 Plumbing Sprinklers ElGenerator E] Roof Roof pitch Total Sq. Ft of Construction: %�pb Cost of Construction: $ 9 S Ft. of First Floor: _ Utilities Sewer O Septic Building Height: OWaI�/LESS' E CONTRACTOR: Name 17±/_nAOAI abf/LL Name: Address: 329/--_<50' , 2_�"/ , 5�5_1_'f Company: iS1 (kowl � oh�b•C�drS 1 ` (� AO %Q K Address:10ISR .S�cr��nc e, G� City:'r&e ' State: � � Zip Code: City:kls2g� Stater Phone No. 7 a - Zip Code: n4 �� Fax: E-Mail: Phone No. K6 t' 30 b- 4% E-Mail: Fill in fee simple Title. Holder on next page ( if different from the Owner listed above) State or County License: Ste- C.�G t51398 if value'of construction is $2500 or more, a RECORDED Notice of Commencement is required. ©� VJ 'SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable Name: ,��%?%/� �i�ii / st/,��2� ,`� 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 Counter makes no representation that is granting a permit will authorize the permit holder to build the subject structure is in Home Owners Association bylaws -or and covenants that may restrict or such which conflict with any applicable rules, prohibit 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/ Lesseetc r as Agent for Owner i re Contractor/License Holder STATE OF FLORIDA STATE OF FLORID I COUNTY OF COUNTY OF The forgoing instrument wasacknowledged before me this � day of!` CA b-A.*- ,//20� by The forgoing instrument was acknowledged before me this ° riday of dcl , 20� by / Ovv✓�Li V'I )n 4 Pn�G Ru j i, S j ✓e , *� Nam6 of person making sta ment Name of person making statement Personally Known OR Pra0siced Identification i,/ Type Identification +°`:•'•.�� ASLAMM•HUSSAIN Personally Known OR Produced Identification Type of Identification of * * MY COMMISSION#FF9 Produced Po L � a .. 42303 / 01111JIJ//�� Produced ! e L•e� 1-4 �� 1��; �s f ' A% kdEXPIRES: ApriIS,2020`��Q•oT�Ak9� udgetNofarySerri�a ♦ • • (Signature of Notary Public- State of Florida) (Sig ture of Notary Public- StD of f4AAl011--- 1 Juiy 11, 2020 Commission No. &C9 t12- 301 (Seal) Commission No. W S tige" 10527 e •O av 00 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION 4.Z Of SEA TURI�L911 I jVpUli5 OVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.8/2/17