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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: I, Permit Number: 1 `� RECEIVED Building Permit Application JUN 19 2010 Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772)•462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR: Address: Legal Description: Property Tax ID #: Site Plan Name: Project Name: Setbacks Front Back: permittingStale Cou►nyent mmercial Residential I Right Side: Left Side: Electric Plumbing _ Sprinklers I _ Generator Total Sq . Ft of Construction: I' . Ft..of First Floor: q Cost of Con; tr ction 3 S 1 0Q,Z . D 0 Utilities: Sewer„ s,lii!Se tic Lot No. Block No. Roof Pitch Building Height: 01NN`ER/LRSSEE CONTRACTOR: Name: ::)`aD Address: `79 wrr �?X �ds� �✓�e�. . " Co" mpany: City:=r-S: .< ,.y i 2 tate:L Addrrys5�5 dc�11C'v�+ City: KState: Zip Code% Fax: Phoiie,No:. "d';,�'S�I-� Q31—) 01400 Zip,code:f`' " fFax: Z I'6�$—S"��s'y Phone No ?_0 (' 3 �j `���t E-Mail �D C.L f-exq i .9—ex-( -A • cZv--% E-Mail: 1 D�,C�ti © �fa�Q D �.Cd wl Fill in fee simple Title Holder on next page ( if different State or County License 6(,o 5' i (,o (,' from the Owner listed above) If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. s SIJPPlEM �NTA! C(3NSTRl RTI ' Lf'EN W 1NFQRMATIO DESIGNER/ENGINEER:- _ Not Applicable MORTGAGE COMPANY: Not Applicable Name: ''° ' _ -Name: Address: 1 Address: City: "" State: ,City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLEHOLDER: _ 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 yowt)Notice of Commencement. I_a_ Signature of drier/ Lessee/Contractor as Agent for Owner Signature of �'ntra�t6r/License Holder STA E O,F'�LORID G 'Qj �1 STATE q DLO IDEA COUNTYOF CO tTY OF\vim The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this�� day of �u�r'r , 201$ by this day off , 20 by (Name. or person acknowledging) (Name of person a ledging ) 1� �laJ (Sig e Nbtary ublic- State of Flo J11111,, _. ,, .. ... , ..,, Late of�Florida) a Personally Known OR Pr 1d i' >SG ✓ �. ' \\NN►Ulllt/� Personally Known OR Prod uced•l�\\Ai 1 ,'ii Type of Identification pp`\ pyH?to�'t'p�%— a Q�p ? Produced gm ; Type of Identification Produced V Commission No. P�'1%Q ®�® ;'k - * (Seal),---- Commission No. �91b0 z ;'(Seal),► y Z. c 0�.:°yAo�ded OFF 9802D0 a REVIEWS FRONT zt3( ,STA ii�ii� !;VISOR \ PLANS VEGETATION SEA TURN, RZI�Q�V� ���1 COUNTER REVI REVIEW REVIEW REVIEW REVIEW 1111f) DATE RECEIVED DATE F T COMPLETED ev.