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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION---- --- k idshk ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r 3� �%� �, Date: _ Permit Number: V `—" RECEIVED Bui ding Permit Application Planning and Development Services MAR 3 0 201E Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 permitting Department Phone: (772) 462-1553 Fax: 462-1578 Commercial Residential St. Lucie County (772) PERMIT APPLICATION FOR: To Select from`dropbox, click arrow at the end of line PROPOSEp-IMPROVEMENT LOCAT1014: , Address: "1 %C '� i�b�'$�r r-nr - � i ere V ) 3Li ON (0 Lo 4. ,b Legal Description: aa� Property Tax ID #: \e� -' �� �� ©� Lot No.,� Site Plan Name: CN_a flr(I CnUA h e rrBlock No. Project Name: Setbacks Front Back: 15'L Right Side: I Left Side: DETAILED DESCRIPTION OF WORK: pi 6 n si ve Wide, hone - CONSTRUCTION INFORMATION: ACIditional work to be nerformed under this permit— check a11 rJapp y: (JHVAC Gas Tank ❑Gas Piping Shutters Windows/Doors _ 13 Electric 0 Plumbing Sprinklers E]Generator F-1 Roof Roof pitch Total Sq. Ft of Construction: S . Ft. of First Floor: 16 �19 LlSeptic Cost of Construction: $ )-&06 Utilities: Sewer Building Height: OWNER/LESSEE: CONTRACTOR: Name OI-kn�ht CC109 tM6 %,e lnrmfe parK Name: Address: 9015 l-s-I Company: Slave [nilAe- . -T-VlC:, City: Pnrk Ot ZtTti' State: Address: , o In S Zip Code: _Fax: City: 1ja 10%e State: Phone No. '7-7 i e M- 4390i Zip Code: 1395c1 Fax: 6-026 I E-Mail: Phone No. &5-1457" iizoq Fill in fee simple Title Holder on next page (if different E-Mail: J­aWS 99 06MCt I . l^QM from the Owner listed above) State or County License: 3 o 6 s If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN. INFORMATION: Name: Address: City: State: Zip: Phone ' FEE SIMPLE TITLE HOLDER: X Not Applicable Name: Address: City: Zip: Phone: MORTGAGE COMPANY: Not Applicable Name: Address: City: State: Zip: Phone: 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 aipermit 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 No improvements to your property. A Notice of Coml before the first inspection. If you intend to obtain commencine work or recordine vour Notice of Coi of Commencement may result in your paying twice for (cement must be recorded and posted on the jobsite ancing, consult with lender or an attorney before c Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA , STATE OF FLORIDA COUNTY OF ,�)� COUNTY OF 1`� �1 The forgoing instrument was acknowledged before me 6, h IZ The fo oing instrument was acknowledged before me this day of 10(A 20 by this day of ft irCh . 20 3 by 3— YA Q: wal' a Io (14r) t Name of person making statement _i:.t` Name of per on making statement Personally Known OR Produced Identification Personally Known ^ OR Produced Identification Type of Identification Type of Identification y� Produced �P r�rtl"e I 0 Sr Ki' own Produced 1'3e_I(n rla 1 Alt Klcc'o (Signature of Notary Pu ' - State c Iorida) (Signature of Notary Publi6gate of Flori ) Commission No. Commission No. �n Notary Public State of Florida PIAM °f Floi �F Victoria Laws , ,NOV OmnlwiAacO asa REVIEWS V&MS0311512(YAPLANS VEGETATIO othr C I REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17 N 1%