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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION• ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date:l PQ IQ 3 Permit Number: I &10_ 0673 W-1 ____......... __ Building Permit Application SCANNED Planning and Development Services 13Y. Building and Code Regulation Division St Luce County 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X Property Tax ID#: Q5a)- 501- 0O)5- OSb- 9 Site Plan Name: _J e.t f\ I 5�Q,,(1 Project aa Name: L] IAA Setbacks Front Back: uo-r. '7& Ii HVAC 11 Electric ❑ Plumbing 11 Sprinklers0 Roof pitch Total Sq. Ft of Construction: 99 � S . Ft. of First Floor: Av4iQ Cost of Construction:$ J5, b00- O CU Utilities:[]Sewer Septic Building Height: �-�3 OV Right Side: Left Side: e ,V o Lot No. Block No. 114 d � fv Ot,-c4h- Name kz% 1 1 % &Yh SM 1 �- Address:cA -4 L4 O ) C. 1Z City: �(_+_ ti C� State:iF) Zip Code:��l q � 5 Fax: Phone No. `lea,- %�}- 4414 �j t1 E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) "Shutters Generator QWindows/Doors © Roof Name: C c Company: nn_4 pC5 Address:'Isq A-E City: �• %Lx�a&,At. State: ) Zip Code:,:!-H 9 5D Fax: Phone No. 1-1'a.- q':SH-- (0 O%L) E-Mail: C ( . G State or County, License: If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. DESIGNER/ENGINEER: i� Not Applicable MORTGAGE COMPANY: Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: 1 Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: Name: Address: City: Zip: i Phone: Not Applicable BONDING COMPANY: Name:_ Address: City:_ Zip: Phone: Not Applicable 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 isl 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 our Notice of Commencement. Signatffre of Owner/ Lessee/Contractor as Agent for Owner SigrAture of Contractor/License Holder STATE OF 1l./CGc� STATE OF COUNTY OF COUNTYOFORIDA�� The for oing instrument as acknowledged D 1pefore me Z 9:74 The forgoing instrumen was acknowledged efore me ��3 �'%C' this day of 20/Y by this day of , 20by 2 6ZIs AW3C, X64.s (:%"-rs n n�✓ Name of person making statement Name of person making statement X Personally Known J� OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced C Produced (Si ature of Notary Public- S e of Florida) (SigFrAure of Notary Public- State of FI a ) OSY PUBIi MARK KENNY a ' c •• UB�% MARK KENNY Commission No. * f�R�i�ssion#GG144499 Commission No. -Sea mmission#GG1 `7 Expires September 19, 2021 N Expires September 19, �lFOf FoF Fjd� Bonded Thra Budget Notary services FLo�`�� Bonded 7tw Budget NotarySe REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE j COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17