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HomeMy WebLinkAboutBuilding Permit Application11 N All APPLICABLE I FO UST `'r•' PLETED FOR APPLICATION TO BE ACCEPTED I I Date: Permit Number: L ` Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Building Permit Application 1� Commercial Residential PERMIT APPLICATION FOR: PROPOSED INPROVEMENT LOCATION ..' Address: 'ZS �)Q(� -S��XXZr)'n 'C -3 Fo,(k 2,12gf e, L 1 Legal Description: Property Tax ID #: ®('� O� '-�© C!) Lot No.-ZT Site Plan Name: Block No. i ,,5q Project Name: M EJ c, 260^ Setbacks Front Back: Rig Side: Left Side: CONSTRUCTION INFORMATION Additional work to be performe under this permit- check all -that apply: _Mechanical _ Gas Tank _ Gas Piping _ Shutters -Windows/Doors _ Electric _ Plumbing _ Sprinklers _ Generator Zoof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ 35 t0C) Utilities: —Sewer —Septic Building Height: 01NNER/LESSEE:;. ,CONTRACTOR:;. Name (?j Q Name: Address: �55 Qc� `OY Company: Address: City: 'FOA T State: Zip Code: -,�L\ 4 S Fax: City: State: hone No.'1�ia-� (D�J ��� Zip Code: Fax: E-Mail: LOQ k, 1. @ U\J(L. CSJ'M Phone No, Fill in fee simple Title Holder on next page ( if different E-Mail f from the Owner listed above) State or C ty License If value of construction is 2500 or more, a RECORDED Notice of -Commencement is required. EER: Name:_ Address: City: Zip: FEE SIMPLE TITLE HOLDER: Name: Address: City: Zip: Phone:_ dN LIED .AW�1lIFC3RI�lI,ATt�}#�. '' •..., ,d..Ya.+F,,° ..s„,u:�� ._. .�.... _., .1.. ,..?"+G�w .._�.� � ..�... .a, +st ._, aX-,� epAw � ''. ,r .-€ .^t. .wfl.Y pp MORTGAGE COMPANY: _ N Not Applicable of Applicable Name: Address: _ State: City: State: Zip: Phone: Not Applicable I BONDING COMPANY: ' _Not Applicable Address: City:_ 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 arje 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. g4ou intend to obtain financing, consult with lender or an attorney before commencing work or rpx-or_0i6g yaW Not' a of Commencement. I Signature of OwneContractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA I STATE OF FLORIDA COUNTY OF SF- LUcf C._ COUNTY OF The forgging instrument was acknowledged before me The forgoing instrument was acknowledged before me this ay of % 201" by this day of 20_ by Name of person making statement. }� Name of person making statement. Personally Known OR Produced Identification i ` Personally Known OR Produced Identification Type of IdentiflKation / Type of Identification Produced Produced Z" (Sign ure of Notary Public- tate of Flor' I Erich Daniel K g Notary ) ��� ss Si nature of Nota Public- State of Florida S 25� oa oNOTARY PUB C Commission No. o -STATE-OF FL RrAmission No. (Seal) c f/� / Comm# GG1 25 * 'Wfbtar NC iPJFF Z NING SUPERVISOR PLANS VEGETATIO SEATURTLE MANGROVE Comm'srs rlordR, IEW REVIE REVIEW REVIEW REVIEW REVIEW Y Comm Expire May ed thrs ' 27, 2 19 ' ugh National ! DATE COMPLETED I / 7 }