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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: _ N- VC MANNED Permit Number: 1 0 Building Permit Application MAR 14 201' Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, For Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential ✓ PERMIT APPLICATION FOR: Si-e10 LQ )-P PR®'PQSED I'NiPRC?1lEMENT LOA IQN: Address: 4�T r', �l (� < 2 99 9 `). {,f�� �'i Nc. Ghee Dtz, Legal Description: TN��9ey j2 t uer�~� 5 �Ur%z'T�-o4- RLi '�� p L611 o -7r%^AIf3 w_\ Property Tax ID #: Lot No. Site Plan Name: i Block No. Project Name: Setbacks Front Back: Right Side Left Side: ��-- QE AfLE© D'E�SCRI�PTI®N OF WdR+ : r) CONSTR�I)CTION N'F®R�MATIO itiona work to be performed under this permit- check all that apply: _Mechanical _ Gas Tank _ Gas Piping —Shutters _ Windows/Doors Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction: 3{ D 11 F Sq. Ft. of First Floor: Cost of Construction: $ 13 SO , as Utilities: —Sewer —Septic Building Height: QWNER IL SSS: E: C®NTRACTO.R: Name R AC/ ,r,,oe l-C> :S 7 Name: Company: Address:' ej eTM ei D 7z P City: ro �z'i. Rr t Vz -C 4f State: _E11D . Address: Zip Code: Fax: City: State: Phone No. -�;77) - Zip Code: Fax: E-Mail: R A C/ IO R�rJ)Tr L 1@ RT-E ),I e. T- 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 C NSTRUCTtC1N LIB LAW CNFOR ATtDN: DESIGNER/ENGINEER: Not Applicable Name:," ;(L To) l� a j � —fi �o� 5 Address:4K �,e,s-►� m C-,4 ybtZAd, &r MORTGAGE COMPANY: Not Applicable Name: Address: City: State: Zip: Phone: City 4# fJ,-- l A I Zip: J77--�0, Phone w I State: P, FEE SIMPLE TITLE HOLDER: Name: Address: City: Zip: Phone: Not Applicable BONDING COMPANY: Not Applicable Name: Address: City: 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. St. Lucie County makes no representatio6 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, t i e 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 i Intend to obtain financing, consult with lender or an attorney before commencine work or recording vour Notice of Commencement. Signature , wn'&rrLessee/Co tractor gent for QyneSignature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF 4 COUNTY OF The forgoing instrument was acknowledged before me The, forgoing instrument was acknowledged before me this day of , 20_ by this day of , 20_ by (Name of person acknowledging) I I (Name of person acknowledging) (Signature of Notary Public -State of (Signature of Notary Public- State of Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced Commission No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW � REVIE REVIEW REVIEW REVIEW DATE RECEIVEDDATE / COMPLETED ev.