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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION9 All APPLICABLE INFO MUST BE COMP Date: / - ' Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462 PERMIT APPLICATION FOR: APPLICATION TO BE ACCEPTED / 'Q Permit Number: SCANNED Bu II>�irl>' der it Application im go �t cI sr Commercial Residential PRfJPOS.ED:INFROVEMENT.LOCATION.. -:a ...` .-;.� Address: :3 i� 61 h1� r�00 P GZ , t- ri i E d�z E� �L 3 I/z 9,2, Legal Description: S ( ry C. L J9 i y $ 7-0 a y lq Fdz)q M , uJ 49 I Property Tax ID #: ��dvZ , �0������ Lot No. Site Plan Name: Block No. �i,Project Name: �'�>"�G1!.C./Im .. Setbacks Front Back: Right Side: Left Side: I °DETAILEED DESCRII?710N QF V114RK a ... I %f b l t, L li dU ii; cff l aV `f 1 (5_ }-1 0- 0 9 �P LAJ i N�D n LU l L4 J-) 1 fy G- hL" g (rub? CCiNSTRUCTION INFORMATION Additional work to be performed under this permit - check a.11 that -apply: _Mechanical _ Gas Tank — Gas Piping _ Shutters- _ Windows/Doors Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction: 4So o Sq. Ft. of First Floor: Cost of Construction: $ ©0 Utilities: _Sewer _Septic Building Height: �IIVNER/LESSEE: Name �fo S E Li (.t4 Name: 6142 N F- P-- Company: Address:-') I) fifl f-1 8 D 0 City: r!.I e: 6z.C_6 State:_ Address: Zip Code: t•cl $ �- Fax: City: State: Phone No. 17 3 -11 �.o�-a Zip Code: Fax: E-Mail: L- I C�IAE\ 3 &D \ 0L4 G LOM Phone o Fill in fee simple Title Holder on next page ( if different E-M it from the Owner listed above) State or County License If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. I SUPPLEtVlENTAL C(7NSTRUCTlON LIEN LAW tlVFdRIVIATlON o DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: I Address: City: State: I ;City: State: Zip: Phone 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: I 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. I 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 mayiapply. In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the woork 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'ladditions, 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 insp ction. If you intend to obtain financing, consult with lender or an attorney before commencing worVoVrecording your Notice of Commencement. Signatur f ,w L ssee/Contractor as Agent for Owner Signature of Contractor/License Holder STAT FLOR A N STATE OF FLORIDA .OF CO TY OF COUNTY OF s'" 2 a The f going instr nt was acknowledge efor The forgoing instrument was acknowledged before me this day of 20111 m N . - this day of 20_ by NNW s �� W (Name of person acknowledging) �,,;,,� (Name of person acknowledging) 4 '<c (Signature of N VryPublic- State of Florida) (Signature of Notary Public- State of Florida ) Personally n OR Produced Identification Personally Known OR Produced Identification ntifica Type of Ide' Type of Identification Produced -'' C Produced I Commission No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REV( REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. /2014