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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: , I fti,NOM ev RECEIVED St LW, Wing Permit Application MAR 3 0 1018 Planning and Development Services Building and Code Regulation Division permitting Department 2300 Virginia Avenue, Fort Pierce FL 34982 S cie county Commercial Residential Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR: T ropbox, n PROPOSED -IMPROVEMENT-LOCATIOi4:1 nie; Vd 349'�� �r Addre, ���� iliac (As— lr°- Legal Description: aa� Property Tax ID #: i �� Q `�C>-1 ®�©� Lot No Site Plan Name: C6-i Mfn1 CQUP (��r�a �P knne of Block No. Project Name: Right Side: Left Side: Setbacks Front_LQ Back: __1'5 DETAILED DESCRIPTION OF WORK: Mo b' Ap mp° d, CONSTRUCTION INFORMATION. r iona wor to e e orme under this permit— check all app y: CJHVAC 0Gas Tank []Gas Piping Windows/Doors _Shutters 0 Electric 0 Plumbing OSplrinklers 0 Generator Roof Roof pitch Total Sq. Ft of Construction: S . Ft. of First Floor: 1609 0 Cost of Construction: $ In�I� 6 Utilities:ll Sewer Septic Building Height: I O�lfNER/LESSEE: CONTRACTOR: Name Wl-k i�hj t 6� f! lhrwy�e_ G #.i((_2 -- Name: Address: Lf l - ` Company: Gkie ui e— G City: 't e�tl State: Address: �� �d4C Zip Code: � Fax: i City: 1 State:, Phone No. o m Zip Code: 033,� Fax: Wa -� 3 `o26 I E-Mail: Phone No. %3— 9616" 620"1 Fill in fee simple Title Holder on next page ( If different E-Mail: V Ln Laws from the Owner listed abode) State or County License: If value of construction is $25500 or more, a RECORDED Notice of Commencement is required. I SUPPLEMENTAL'CONSTRUCTION LIEN: AW INFORMATION: DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: X_ Not Applicable Name: Name: Address: I Address: City: State: I City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: X Not City; Zip:. BONDING COMPANY: w. 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 prio� 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, ti 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 fro 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 owce 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. Ifyou intend to obtain financing, consult with lender or an attorney before commencine work or recordine your Notice of Commencement. el - Signature of Owner/ Lessee/Contractor as Agent for owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF PCAK COUNTY OF_ 0� The f r oing was acknowledged before me 6-, it The forgoing instrument was acknowledged before me this day of MCA IrCV\ 20A by of , 20a by thisA day of HIVl a , Name of person making statement Name of person making statement n Personally KnowOR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification �/ _ ( Xk Produced r Cr1r�10i V �:PYIwo Produced 'De-0;Q t ICi f 1�10(10 (Signature of Notary Pu ' - State lorida) (Signature o Notary Publi - ate of Flori ) Commission No. Commission No. of Floii� Notary Public State of Flori Vs ictoria Laws , Lam tgra� REVIEWS my %1W PLANS VEGETATC REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17