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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION 6-4-18All APPLICABLE. INFO MUST BE Date: O(Q l 0 4-1 L 10 Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462- )R APPLICATION TO BE ACCEPTED �p Permit Number: �� �o� 5GAN�s�pUNIT cJ ERECEIV—ED Building Permit Applicati201$ � f'armitting Commercial . Residential r PERMIT APPLICATION FOR: A ' LJ ® C ► © ` C'1 u' . y spr _ a'IdI �: 7 81 it .r. � ky n a ads Address: 5313 A t L Legal Description: Property Tax ID #: 0!2 / 1-0 2— — (Pd3 Site Plan Name: Project Name: Setbacks Front Back: CAk 39 - 000- 5- Right Side: Left Side: 3 8 2 .f. Lot No. 45 Block No. 151 Additional worK to be performed under tni permit— cnecK all tnat apply: _Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors Electric _ Plumbing _ Sprinklers _ Generator � Roof Pitch Total Sq, Ft of Construction: 2 Sq. Ft. of First Floor: Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height: OW=IVER/LESSEE: C0 RAC�+1�®R Name ki to Name: Address: i�77311 City: ` i E I Wrt Company: State: A Address: City: State: Zip Code: Fax: Phone No Zip Code: � 7 3 5 Fax: Phone No. 11 �� — Q �q E-Mail: Fill in fee simple Title Holder on next page from the Owner listed above) ---1 p 3 6(1 � ( if different E-Mail State or County License e of construction is 2500 or more, a RECORDED Notice of Commencement is required. St.IiPPEM�ENTAL CC}N R CTIpN LI ., LAW I FQRMA IQ ; DESIGNER/ENGINEER: Name: _ Not Applicable ;,, . _ _ MORTGAGE COMPANY: _ Not Applicable Name: _. .. _. Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: Address: City: City: Zip: Phone: 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. v, Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORI A COUNTY 's� 1- �� STATE OF FLORIDA OF COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of ZyiN-t 204 by this day of. 20_ by y � � dt �r � c �n -► 'hc� �. Z (Name of person acknowledging) (Name of person acknowledging) (Signature of Notaryblic- State of Florida) (Signature of Notary Public- State of Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced duced DEANNA MARIE GIVENS 5$1-,' Commission No. (S@It�OMt�IISSION#. 0002202 :a EXPIRES: December 16, 2020 C mission No. (Seal) Bonded Thru Notary Public Undenvri . REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.