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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONII. All APPLICABLE INFO MUST BE Date: I LETED FOR APPLICATION TO BE ACCEPTED Permit Number: Planning and Development Services Building -and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 ' Fax: (772) 462-1578 I. RECEIVED. Building Permit Application OCT 10 2018 DST. Lucie County, Perm[ MANNE By Commercial St LUeie R"e41db,iitial Property Tax ID#: 1-C Uyy v Site Plan Name: ProjectlName: Setbacks Front Back: Right Side: worK LO De Derrormea unaer inns Permit — nical _ Gas Tank — Gas Piping — Electric — Plumb•ng — Sprin ers I � Lot No. - Blo.ck No. Left Side: — Shutters indows/Doors Generator Roof ''D Z. Pitch Total Sq. Ft of Construction: Sq. Ft, of First Floor: Cost of Construction: $ , :; a0D Utilities: —Sewer _Septic Building Height: Name l A11WIPA C91al"o Name:_ lit'/_1 IWA 64-11' Addres ��`� �i C • ompany 9MU i City: State:f/� Addres V S� Zip Code Fax City:W41,1? StatePhone'INo. Zip CodFax: E-Mail' Phone No I Fill in fee simple Title Holder on next page (if different E-Mail from the Owner listed above) State or County License If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. _ / _-_ _ r ./ _ all 1L DESIGNER/ENGINEER: _ Not Applicable Name: City: State: Zip 1 ne FEE SIMPLE TITLE HOLDER: _Not pplicable Name: Zip: St. wh In c in a The MORTGAGE COMPANY: _ Not Applicable Name: Address: City: State' Zip: Phone:. BONDING COMPANY: _Not Applicable Name: Address: City: Zip: Phone: ER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated. y that no work or installation has commenced prior to the issuance of a permit. e County makes no representation that is granting a permit will authorize the permit holder to build the subject structure s in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such re. Please consult with your Home Owners Association and review your deed for any restrictions which may apply. ideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work rdance with the approved plans, the Florida Building Codes and St. Lucie County Amendments. owing building permit applications are exempt from undergoing a full concurrency review: room additions, rry 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; cones with lender or an attorney before comrriencim work or_cecordine vour Notice of Commence—mmt. ture of O ne Less /Contr ctor as Agent for Owner S' nature of C ntract r/Li nse H er rTATEOFF ORI A ' STATE OF FL RID _ COUNTY OF COUNTY OF The fosgoin y ins nt vQas acknowledge efore me this day of -� 20 � b The ringinstr m W `sack nowledgRhbefore me this dayof 20I_ b (Name of pers acknowledge g) i c- (Name of person ac nowledging ) (Signature of Notary Public- State of Florida) (Signature of Notary Pub Ic- State of Florida) ✓c- Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced S. N I E LS E N o e,- KAREN S. NIELSEN ,_ :State of Florida- fly Public Commission N �• - '- ``"aYP"°i° - �� :,State of Florida -Notary Public Commission No. =* •= Commissio(Sea p 207484 �', ssion # 07484 Orr My Cornmission Ex fires if' °ii�i��`� P +. -. F o My Commission E:xpir©s '''°��`��"� June 12, 2022 Jun REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE 'MANGROVE " COUNTER REVIEW REVIEW . REVIEW REVIEW REVIEW REVIEW DATEI RECEIVED 10,11 DATE1 9 r 110 COMPLETED I , Rev. //`/-U14