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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLET `, 'FOR APPLICATION TO BE ACCEPTED _. �. Date: • of • I Permit Number: E V + tom:- q �p g�4 � r - Cl�t� i 6 �lf I� _ Building Permit Application DEC Planning and Development Services PER! s1171 dG Building and Code Regulation Division St. Lucie County, FL 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: PR09M`ED IN . a ENT L®CAT OMN: J Address'. Legal Description: Property Tax ID #: �' • ©( I Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: D TAILED DE�SCRhPTION 0'f WORK: 651,Z 4 C, e LU°�cs�e�� CONSTRUCT ©N 1NF®,f� ATI©N: Additional work to be pertormed under this permit —check all that apply: _Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Electric _ Plumbing _ Sprinklers _ Generator Total Sq. Ft of Construction: Sq. Ft. of First Floor: I • Z 60 Cost of Construction: $ o Utilities: _ Sewer _ Septic Building Height: ®WtN ER'%f'�ESsEf" CO'NT 'rACTOR Name: Name -- Address: 04— l�L�• i5/F Company: City: State: Address: Zip Code: Fax: City: State: Phone No. %�y Q�y—,y Sy Zip Code: Fax: E-Mail: &ML4 7gM24 #0% /,'� L� .eOp4 Phone No Fill in fee simple Title Holder on next page ( if different E-Mail from the Owner listed above) State or County License If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONST' U� 'I + N LIEN LAW I �OR�11//IATI�QN: DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable Name: Name: Address: Address: City: State: �_ City: State: Zip: Phone I I Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: I Address: City: I City: Zip: Phone: I 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 pri , r to. the issuance of a permit. St. Lucie County makes no representation that is grantin 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 Buildi� g 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, sign$, 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 commencingwork or recordingour Notice of commencement. Signature of Owner/ Lessee/Age t . Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF i A C_ COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this JQJ day of 2012 by this day of 20_ by rA iG j :1Jjig6jf/1-9ZAJ j (Name erson acknowledge ) (Name of person acknowledging) (Signatur of Notary?'ublic- State of Florida) (Signature of Notary Public- State of Florida ) Personally Known ' ( OR Produced Identification Personally Known OR Produced Identification Type of Ide Type of Identification �tateof lorida Produced ;1ollyn:nIaDrallusal Commissio on FF 19WL3aI) ►� /2019 Produced Commission No. (Seal) REVIEWS FRONT ZONING SUPER IISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIE REVIEW REVIEW REVIEW REVIEW DATE -'RECEIVED DATE COMPLETED Rev.