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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED Date:,. 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: APPLICATION T:O BE ACCEPTED 7 SCANNEDPermit Number: BY St. Lucie County Building Permit Application Address: i3 s Ss Hwy l Legal Description: Commercial Residential Property Tax I D #: 3 V i Ll - So / - 1 9 / (e - 3 5 D " % Lot No. Site Plan Name: Project Name: Setbacks Front Back: Right Side: Left Side: Block No. G l %tie For 3 -/a h /3 S eC r- Over- -Mechanical _ Electric _ Gas Tank Total Sq. Ft of Construction: Plumbing Cost of Construction: $ 5 permit - Gas Piping _ Sprinklers _ Shutters _ Generator Sq. Ft. of First Floor: Windows/Doors Roof Utilities: —Sewer —Septic Building Height: Name Q/ De t / a/( - v rx env PU w Address: g -7,-3`7 US f-f cI / City: 20rf S f L00�e ' State: FL Zip.Code:- .,:3t1q5a Fax: Phone No. E-Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) Name: %rti5 Sq..mynon S Company} i' 5-.rem A t r- S!� sfems )IV c, Address: IWS ran Dr City: `P6e--r State: FL. Zip Code: 342_Sb Fax: ` ?a 33Y I U 9 Phone No. 77d_ 336- -3�-32 E-Mail: (LUtolir 54 t V ao ) -r,M State or County License: CAC 0 S 191© - S4cz1f2 . If value of construction is 269dor more, a RECORDED Notice of Commencement is required. 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 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 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/ A e t/ Lessee Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF S-� LUCL-1(2- COUNTY OF S-� Uoe►c The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this -)S day of /4vqu a f- 20 N by this --$s day of P 090S t 20 ry by C. �S63M L lay,es . (Name of person acknowledging) (Name of person acknowledging) (gig -nature of Notary PubIV- State. of Florida) (Signs ure of Notary Public- St of Florida ) Personally Known '� OR Produced Identification Personally Known OR Produced Identification Type of Identification Produced Type of Identification Produced Commission No. /U(P *,Oal�PEBRA L. JONES # EE1061 ommission No. EE1 U tp tea' " alMOMMISSION DEB�L. JC►NE MY IRES: Sept= ba 05. 201 COMMISSION # EE1061 t ? EXPIRES: S� 1•BOtIJ.NOTMY . Fl. ijuu Discount pain, REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE M COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 7/2014