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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICAB E INFp MUST BE COMPLETEEb Date: I 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: t APPLICATION TO BE ACCEPTED ; Permit Number: SCANNED BY St. Lucie Count%, Building Permit Application Commercial _ X _ Residential ■&1No] 991A2III lkliu;de1yl91oiln0R1111[0iM3111910 1 Address: Legal Description: Property Tax ID#: 3s3 Y © 90 7 -pDD 3 Lot No. Site Plan Name: ✓� c--Block No. Project Name: rpC6�yC'tV /S7G/�ity �l>l 'c CmV'00 �sSQG Setbacks Front I Back: RiPht Side: Left Side: 1 DETAILED DESCRIPTION°OE'WORK: s�* CONSTRUCTIQN INFORMATION: x ` AUUIEIUndi worK iU De perrorrneU unaer uus perrna— LnecK au Lndi apply: _Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors Electric _ Plumbing _ Sprinklers _ Generator _ Roof Total Sq. Ft of Construction: Z Sq. Ft. of First Floor: Cost of Construction: $ x 'MOP Utilities: —Sewer _Septic Building Height: OWNER/LESSEE:: CONTRACTOR:,g e, Name49aAl,G6 Zd Name: /54�� Address: Company: /n/G06 City: s%t/91CRI/ Stater& Zip Code: —?XZ Fax: Phone No. c9 oZ q — J3 546 aoe / rf >,6 Address: 14 2C0-Sca ,6l/_T/�1172LSs! City: /PVxr BSI. z-&4wc State:Z� Zip Code: F Sl g8•!j� Fax: 8'%/' ©% o Phone No. rs} 7/— / %/s E-Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail: �i GL C XPG.,el %DG State or County License: l6 S 7a If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. ./ SUPPL ENTAL'CON , • CT(ON LIEN LAW J , FORMATIO .% '" ... ,.ar°^. .a sore`,+ rt 'dr?. DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Applicable Name: _Not Name: Address: Address: City: State: City: State: Zip: Phone: Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Atpp icable Name: _No 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 bylaws rules, 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 commencinR work or recording,,Aur Notice of Commencement. Signature of Owner/ Agent/ Les ee 6 Signature of Contractor/License of er STATE OF FLORID '-— / STATE OF FLORIDA COUNTY OF \ /_ COUNTY OF SA- Lc The oing instru t was acknowledged before me this day 20 The fgcgpin g nstr ent was acknowledged, e me of y this da of 20 (Name of person acknowledging) Dj\�� P\ a (Name of person acknowledging) -a ,, J M (Signature of Natal ata Public- State of Florida ) - (Signature of ublic- tate of Florida) �Wjo�ary Persond ced identification Personally Known V OR Produced Identification Ir Type o d ` f?Latio�yP 13 Type of Ident isatio� ESAcLiSced ` EXPIRES: April 12, 7_015 � � .Commi I( d0., BondedThruNolzryPublicUndenmiers -eal) i..... Y�,, ANGELA M. HUFF Commission :yE ••:+= F.4YCOMNISSIONREEOa(SPaI EXPIRES: April 12, 2015 a,�, I''",pf Bonded Thm Notary Public Undmnrare PLANS VEGETATION SEATURTLE MANGROVE REVIEWS FRONT ZONING SUPERVISOR COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.