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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i [(`*((�.� � Date: Permit Number: 11 U6 . ((VIP SCANNED • BY Building Permit Application St. Lucie county Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ­�!5' Residential PERMIT APPLICATION FOR: PROPOSED INPRQVEIVIENT LOCATION} , _.. Address: �Do`Z Ctk�AM4tonJ9 cJh•t 70¢-T 5�. )ueAE FL. 3�198G Legal Description: JIr2TYXIiA 26AA eEsor—T Property Tax ID #: 5cl- Lot No. 27 4!r S -t Site Plan Name: J 7$i kJd4 1?6Lh 1'Z6bouT Block No. Project Name: Setbacks Front Back: Right Side: Left Side: �E'A7t uK i.cJG /U fcrraV I�oA2 SLckRs [ALL is Z7AnJG r¢.,A.MEe (4,,,oncl AtiQF To _Mechanical _Gas Tank _Gas Piping _Shutters _Electric _Plumbing _Sprinklers _Generator Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ I Ifilibi5 '# y,LC 9 Utilities: _Sewer _Septic ,e`�W i ndows/Doors Roof Pitch Building Height: OWNER/LESSEE- f „ _ CONTRACT®R:t Name 11.1.�&F, 007-Trt C nJVO AJOJeJoA A$S. IA) Name: NETT L.Jg' I 1 K S Address: gooa 5w.j elrme o CT Company: 'Z ,Ajmvi%a� City: tjmc rs oe Zip Code: 3a2819 Fax: Phone No. 41to. ;�44 ef State: EL Address: S ! S- I tJ. 5tk4r>ELy4NA ICJ F City: ?,u D I A W -S-20 CA S Zip Code: Phone No je(,6 - State::LdJ Fax: (',�(4) gsE g- 21c1'- -(got E-Mail: 92„:. %9-cA)A)6,,tAa.0 A to, Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mail A2G.42C © iZE,y o g a". Co -\ State or County License C Cie 14a 2eoc.) If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL GONSTRR FORMgTIOfV: DESIGNER/ENGINEER: _ Not Applicable Name: MORTGAGE COMPANY: _ Not Applicable Name: Address: Address: City: State: Zip: Phone City: State: 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 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;,p'erform 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-iri 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 arf attorney before commencing work or recording Vour Notice of Commencement. Signature of Owner/ Lessee/Contractor-as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF fk6RtOPr COUNTY OF -•', COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of 20_ by this _ day of . 20_ by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Public- State of Florida ) (Signature of Notary Public- State of Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification' Type of Identification Produced Produced Commission No. (Seal) . Commission No: (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: ' DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable Name: Name: Address: Address: City: State: Zip: Phone: City: State: ZIP: Phone FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Applicable Name: _Not 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 Hpinq Owners Association rules,.bylaws orand 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 attornev hefnrP commencing work or recording our Notice of Commencement. /ontrI &t.rIZUhnfl. of Owner/lessee/Contractor as Agent for Owner rrSignature Signature o Contlder STATE OF FLORIDA STATE OF FtORtB* =JV*-* A COUNTY OF COUNTY OF_ M oLr i an The forgoing instrument was acknowledged before me The forgoing lInstrulnent was acknowledged before me this_ day of _ . 20_ by this &lhday of .2011 by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Public -State of Florida) (Signature of Notary Public- State of Florida ) Personally Known OR Produced Identification Type \y���uuuuu��/// Personally Known OR Produced Itk�it�ii C of Identification Type of Identification .° ti .... c.. ���� Produced o`�c ProducedPUSLI Commission No. (Seal) '. NOtPR A 650381 '' . m Commission NoiGr�0.381 OTSEP REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURne";/,,, COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW@VI W DATE RECEIVED DATE COMPLETED PV