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HomeMy WebLinkAboutBuilding Permit Application.a L ALL APPLICABLE INFO MUST BE widIPLETED FOR APPLICATION TO BE ACCE ' ' D Date: Permit Number: 1 I—" CIOU 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 ?Q PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �pp PROPOSED IMPROVEMENT LOCATION. Address: 92 15 `34 Legal Description: �►� e. �—CSC-+� ��(t ( \-z Lk is - \2'S l 01 TZ Property Tax ID #:n34 Z % — 03 (06 l 6 — C©©— Lot No. 6 2 1 Site Plan Name: r1�, (k Block No. $' Project Name: 64� Setbacks Front 9 Back: Right Side: Left Side: 'CONSTRUCTI'ON INFORMATION ., itiona work to -be performed underthispermit — check all apply: Gas Piping _Shutters Q Windows/Doors 11HVAC Gas TankEl nElectric Plumbing ❑Sprinklers 0 Generator ® Roof/ Roof pitch Total Sq. Ft of Construction: 9 (404 ` S . Ft. of First Floor: 7 4 ( V Cost of Construction: $ 901000 Utilities: Sewer Septic Building Height: OWNERAESSEE:.. =. ,,. " .CONTRACTOR: Name llZ.Zc:�..?'�e- °fie Name: wl Et O 6te �W Address: 32- 4('6 Company: QI: CQ�i�UGcoCl, 97 PoOFMJA City: .!;�o%:V EA State: V Address: 2?66 50 Srt Zip Code:314q S Z Fax: City: State: VG - Phone No. Zip Code: ��q5 � Fax: 133 I✓' E-Mail: f 6%, Phone No. 23Z — q el q Fill in fee simple Title Holder on next page ( if different E-Mail: &—C( KC0.. from the Owner listed above) State or County License: CCCr b (o Z3 If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRquTION 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. 04" v4u" owk _HOAAAI�`5 U 0 Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA COUNTY OF �=7 \Q\.`C.xy STATE OF FLORIDA COUNTY OF S-T• 1--�c�G The for ng instrument was cknowledged before me NOSe�`•� The for ng instrument was acknowledged before me �y this �_ ay of , 20�by this oZ of 20_V:�_by Name of person making statement Name of person rpaking statement Personally Known FOR Produced Identification Personally Known a/ OR Produced Identification Type of Identification Type of Identification Produced Produced (Signature o� ptaaryPublic- State of Florida) (Signatureg ary��lic-- State of Florida ) 7 Commission No. PAULETTE GLAIR -A ommis on No.`�`I �N�•y p , (A��TTE GLAIR ALEXAN EXANDER �►R �a�; 3 • :° E Notary Public - Stat -•. . ; of Florida .° = Notary Public - State of FI n9 aQ Commission # F _'_�• 995699 Commission # FF 9956 Y omm. Expires ep 6, 2020 y omm. Explie REVIEWS FRONT VEGETATION RRiE w - COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED tev. 8/2/17