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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOIJ Date: x? `e SlC PJRJION TO BE ACCEPTED Permit Number: �GIQ • (�'� hPA1110 '4uno� aio uaw Lo eda n 7 'aS supa!waad Building Permit Application 8101.9I Nnr Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 a3n13J32f mmercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED: IMPROVEMENT;LOCATIO.N Address: i2-%/AF7 L'�� eAt1lli z Legal Description: Property Tax ID #: Site Plan Name: Project Name: Setbacks Front Back: NOW Right Side: Left Side: Lot No.6 / Block No. DETAILED D:E$.CRIPTION OF WORK: - �Zao� -c11,74- -A 147- A5- "S77Cl' CONSTRUCTION INFORMATION. i .._ Additional work to be nertormed under this periit - c ec a t apply: ❑HVAC 0 Gas Tank []Gas iping_ Shutters ❑ Windows/Doors ❑ Electric ❑ Plumbing S ri�klers ❑ Generator Jz Roof / Roof pitch Total Sq. Ft of Construction: cc) S . Ft. of First Floor: Cost of Construction: $ �i' 0 Utilities: — Sewer ❑ Septic Building Height:_ OWNER/LESSEE: j CONTRACTOR: Name H14-110% Name: rs_o 5 1 !14 Company:,TAX7/N Address: 9) /6 NL 7d5 M-U 2 City: State: Zip Code_; G 95-7 Fax: I Phone No. E-Mail: i Fill in fee simple Title Holder on next page ( if different from the Owner listed above) I Address:,A, 0 Y,2) 0X/ FY'C 1 I City: �s"G State: Zip Code: -TV 98E_ Fax: Phone No. 772- - �<%/ - !7a E-Mail: State or County License: cc c z1© If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. 21 SUPPLEMENTAL CONSTRUCT N GIEN LAW'INFORIVIATION DESIGNER/ENGINEER: Not Applicable Name: MORTGAGE COMPANY: Not Applicable Name: Address: Address: City: State: Zip: Phone City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable Name: Address: City: BONDING COMPANY: _Not Applicable Name: I Address: city: Zip: Phone: 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 representation that is granting a p Irmit 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. Inconsideration 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 Cq' des and St. Lucie County Amendments. The following building permit applications are exempt from u dergoing 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. 7'2�- SignatudIA Owner/ Lessee/Co tractor as gent for Owner Signature of Contractor/License Holder STAT , STATE O U T AMY APONT CO LIN AMY A APONTE i': •: MY MAMSS10 p FF962064, C MIS Nit F The f go g• ' en W g�d2� re e The for u I�d�@S ore me this � irw.w. �� ; this��, +h y TPersonay per rima9Lkin s atenTent—� aof p son . ing s men 0 rd ce Ident'fic tion V Personal) K w R Pro u entification do�@��j I i pe f Id fi atio roduc d� r , `ic' ` co 5-0 .� ignatur �Not y P blic- to of Florida) nature f Nota ubli - State of FloridaCommission. 'X� (Seal) Commission N . (Seal) REVIEWS I FRONT I ZONING COUNTER REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17 S REVIEWOI I REVIEW VREVIEWEGETATION I S REVIEW I MANGROVE