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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLEVEL; iOR APPLICATION TO BE ACCEPTED Date:`c.\ T1 ra�1\G Permit Number: — SGANNEU BY Building Permit Application9t. Lucie Counti 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: �'oa-�- Address: Legal Description: Commercial_ Residential Property Tax ID #: W 3 i' jo ! —02 S' 3 — 0� / � Lot No. Site Plan Name: y l 1 Block No. Project Name: Setbacks Front B k: Right Side: Left Side: Aaanional warK Lo oe perlurmeu unuer unb Pe I I I II L— a icon a i uwL apply. _Mechanical -- _ Gas Tank _ Gas Piping _ Shutters —Windows/Doors, _ Electric' _ Plumbing ,� _ Sprinklers _ Generator Roof Total Sq. Ft of Construction: yy V `� Sq. Ft. of First Floor: IVA, S Cost of Construction: $ ' L2av OZf Utilities: _Sewer —Septic Building Height: ©W,NER/,LESSEE: GONTRAC«TOR: Name 'N S Address: �� 11 ' �'�' ., :' �Gom an •- Address: ,Z N r 7 CAV _N City: Q �2 C2 �- -r i6 State Zip Code: 34°1 %V� Fax. Phone No. City. Zip Code: Fax Phone No Stater E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mail &W 5 d/v State or County LicenseeCG 132 If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTALGONST TON LIE LAW INFOR,IiiMATION: DESIGNER/ENG t R: _ Not Applicable MORTGAGE 0 PANY: Not Applicable Name: _ Name: Address: Address City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable Name: 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 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 firs ' spection. If you in end to obtain financing, consult with lender or an attorney before comm' ncin rk or reco_l;ding Voifr Notice of Commencement. gna r of Owner/-Lessee/Contra for as Agent for Owner STATE OF FLORIQQA COUNTYOF �J{ LVC �e Signa a of ontractor/License Hold r ST E OF FLORIDA q� COUNTY OF S}•LJc The forgoing instrument was acknowledged before me this day of 6 c_,A 20-X by The for oing instrumen was acknowledged before me this a.� day of — 17 20'W by 1r1 o�j a, Cagy6A-A 1, lo3 a Gays-�-A' (Name of person acknowledging) (Name of person acknowledging ) I (Signature of Notary Pu is -State of Florida ) (Signature of Notary Public- ate of Florida) Personally Known OR Produced Identification Personally Known OR Produced Id tion Type of Identification Produced �. L Type of Identification Produced L0 � E e pgp23 � EGN GA H ��des' Commission No. � �6' 4:,,�,q't:4.'••,�} �tp�SN�NP,�p�W 5,3, D ,_.%� CommissionON Ea REVIEWS FRON ''": COUNT' a• G REVIEW SUPERVISOR REVIEW PLANS REVIEW VEZETATION REVIEW SEA TURTLE I REVIEW MANGROVE REVIEW TEEIVED TEMPLETED F El