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HomeMy WebLinkAboutBUIDLING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE Ctirv,'PLETED FOR.APPLICATION TO BE ACCEF,7 a ' Date: SCANNED Permit Number: ALM BY St. Lucie County RECEIVED ILML41, 40 _ purl Building Permit Application D tnre permittinggDepartment Planning and Development Services St. Lucie county Building and Code Regulation Division / 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1.578 Commercial Residential PERMIT APPLICATION FOR: - Address: ; L Legal Description: PropertyTax ID #: y Site Plan Name: Project Name: I ( Setbacks Front Back: Right Side: Left Side: _Mechanical _Gas Tank _Gas Piping _Shutters _Electric _Plumbing _Sprinklers _Generator Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ ©©G Utilities: _Sewer _Septic Lot No. Block No. _ Windows/Doors Roof Pitch Building Height: OWN€RJ ESSEE: jPIP _, . ry�t CONTRACTOR: Name 1� GC Name: voV Pry Address: Compan� ` �� City: I l2 State: _ Zip Code: 1 Fax://� Phone No. �� `C PJL��U Addre . u �— City: -1 Zip Code: ` Phone No State: — Fax: !, (/ E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mail State or County License C J If value of construction is 2500 or more, a RECORDED Notice of is SUP LE011 TAL CO STRUGT LIEN LAW I FORM 11 DESIGNE NGINEE • _ Not App fgajil M TGAGE COMPANY: _ Not Applicable Name: -• r �— Add_ r s: dress: Cit . G St te: City: State: Zip: Phonei4A e Zip: Phone: FEE SI TITLE :HOLDER: _ Not pplicable BONDING COMPANY: _Not Applicable Name: Name: Address: Address: City: City: Zip: Phon Zip: Phone: OWNER/ CONTRACT&R 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 first inspection. If you intend to obtain financing, consult with lender or an attorney before commencing work or recording our Notice of Commencement. Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF The forgoing instrument was acknowledged before me COUNTY OF w 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 SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW. DATE RECEIVED DATE COMPLETED ev. oIf, 0Jly'- . utaturvert/enu�Ntett: _ Not Appllcanie MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable I BONDING COMPANY: _Not Applicable Name: Name:_ Address: Address: 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 accessary 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 orrecording your Notice of Commencement y}[ 'i - � 0... t .. .'}•Y Sig Lure of Owner/L see/ a Yracto,Agen;natuteofContra"oi{Lic`e`)s'e'Ho e a ", & STATE OF FLORI STATE OF FLORI A m8 9 COUNTY OF x COUNTY OF GtiGt�c a a mis m The forgoing ins [ ent was acknowledge befo this �OO day of 20 by The fo`go_ing instru t was acknowledged before m this o day of 20 by g = a. ;V r lam/ U T �OA -/ /lX G�T2 m�911 / m rr't, tea e'.�. (Name of per on acknowled i g) (Name of pers9A acknowJle�dg (I (Signature of NotarU Public- State of Florida) (Signature of Not6ft Pu lic- 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 SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Kev.//ZU14