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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE Date: j �g PLETED FOR APPLICATION TO BE ACCEPTED Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR: Address: Legal Description: ;r Permit Number:/ 0 ��7�� ZOAN�1NO BY RECEIVED at Lucia Co Building Permit Application �A" s 2ot� Permitting Department St. Lucie County Commercial Residential v,"'- 3 14 Property Tax ID #: ,N q • 5/ o - coga . 0o w— Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: ' s • '� e/ IRS •. ional work to be pertormed under this permit— cnec Mechanical _ Gas Tank _ Gas Piping _ Electric _ Plumbing _1 Sprinklers Total Sq. Ft of Construction: q(C,U Cost of Construction: $ Da00 Utiliti( Shutters _ Windows/Doors Generator Roof aVPitch Sq. Ft. of First Floor: Zoo 5" s: —Sewer _ Septic Building Height: t�W N ER jLESS'EE � 7 Name : A a w r. Name MEt_ Address: 3 CO Company: gr::'•,.; ;- City: Q© - J S4, L Vc3 State: P I. Address: Zip Code: 3 r-f C1 C� D_ Fax: City: " State: Phone No. `? % �' 3 �� " 8 Zip Code: Fax: E-Mail: C( u.) A OW (�0 rna• I - Co M Phone No Fill in fee simple Title Holder on next page (if different E-Mail State or County License from the Owner listed. above) If value of construction is 2500 or more. a RECORDED Notice of Commencement is required. DESIGNER/ENGINEER: _ Not Applicable Name: Address:.-.., City: State:' Zip: Phone FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: Address: City: Zip: Phone: MORTGAGE COMPANY: _ Not Applicable -Name:_ Address: City: Zip: Phone: State: BONDING COMPANY: Not Applicable Name:_ 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 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 your Notice of Commencement. Signature of Owner STATE OF FLORIDA COUNTY OF ,t;$ as Agent for Owner The forgoing i ment was �efore me this3� day by t-1 _ (Name oi;-3erson acknowledging (Signature of Notary Public- State of Florio ) Personally Known OR Produced Identification Type of Identification Produced LASHAHNAINGRAM ��� Pu4:•. No >6 blic State of Florida Commission No. Tres Dec 20, 2018 '£ Mymm. ExP FF 177249 commission #^^ni Nntary Assn Signature of Contractor/License Holder STATE OF FLORIDA COUNTY OF The forgoing instrument was acknowledged before me this day of , 20_ by (Name of person acknowledging) (Signature of Notary Public- State of Florida ) Personally Known OR Produced Identification iType of Identification ,Produced Commission No. (Seal) REVIEWS FRON SUPERVISOR - PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE a, RECEIVED DATE COMPLETED Rev. 7/2014 5