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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONLot No. Block No. All APPLICABLE INFO MUST BE %.%jMPLETED FOR APPLICATION TO BE ACCE ED Date: Permit Number: �11� 3L Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772)', 462-1553 Fax: (772) 462-1578 Building Permit Application Commercial Residential SCANNED BY St Lucie County PERMIT APPLICATION FOR: i PR®,PaSE®1NPR©DEMENT L®CATigN: Address: i% Y ��_ �'�-/% ��lP/9� i� / �,��r�� S "f P-57 _ Legal Description: �P%✓� rp C-i x hic (10f 4�__ Property Tax I #: J 3 Site Plan Name: A Project Name:, Setbacks Front. Back: -� Right Side: Left Side: 1� _Mechanical _ Gas Tank —Gas Piping _ Shutters Windows/Doors Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction: / l Sq. Ft. of First Floor; 1' [ -2 6f Cost of Construction: $ 2°7 G Utilities: —Sewer —Septic Building Height: , go . t=c v� .._ U. Nah�e -e L °P�� c9m'p riy' t �. >.t� n rt: State:lc4 Address %S° Gt Sri �L �r v ,� A dip Code:'` W �S Fax. City „• xR r�vt „,... ,f�:� �,. ;:. State:I-1Z° Phone No. Zip Code: Phone No Fax: —� E-Mail: Fill in fee simple Title Holder on next page ( if different E-Mail State or County License ./1.2 l& 6 from the Owner listed above) If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. S P MEN AL; �C3NS Lt LA DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: '• - BONDING COMPANY: Not Applicable 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 is -with -covenants which in conflict any applicable Home Owners Associatiomrules, bylaws or and 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 obtainjinancing, consult _with lender or- an attorney before .commencing work or recording our Notice of Commencement. Si nature of er ssee/Contractor as Agent for Owner ig atu7ret r/License Holder STATE F FLORIDA Ua STATERIDA COUNTY OF l e_, e_ COLIN The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged befolre me this day of 1 �7 , 20 by this day of i l3 20ja by (Name of person acknowledging) a of person acknowledging ) Si nati.r f otary Public- State of Florida) (Signatu of Notary Public- State of Florida ) Personally Known e'— OR Produced Identification Personally Know OR Produced Identification Type of Identification Type of Identification Produced Produced °Y •. BRENDA ROMERO ZELAYA Commission No. G 6 Notarr��gffp State of Florida Cortlmusidn M GG 208712 , , BRENDAROMEROZELAYA r 5—v�°G Commission No Cf€ Notary� ,¢�4 State of Florida Coda Fs� i#, GG108712 My Comm. Expires Apr 18, 2022 :.a n„ My Comm. Expires Apr18, 2621 Bonded through National-Noiary Assn'. REVIEWS FRONT SUPERVISOR PLANS VEGETATION. SEATURTLE MANGROVE ZONING COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 7/2014