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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: l Permit Number: J �� Building Permit Application 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 Residential PERMIT APPLICATION FOR: PROPOSED INPROUEM'ENI LOCATION: Address: Y' f"•a R`1' P I C–RC L — Legal Description: Property Tax ID#: 2-417 - 2 f(L (0o o z- (,)(RC1/? Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRfhPTI©N OF WORK: � r � n� 2 ;-1 k (.t) P C_ QfZ C©NSTRllCTtON INFORMATION: itiona wor tobepertormed under this permit-check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ Utilities:' ~°Sewer —Septic Building Height: t •ntii OWNER/LESSEE: C®NTRAC'f®R: Name 0-ki 1 L /-lo(Y1 S Name:. d, Address: 9 lzc Company: City: I/e IR 0 (= , rd State:- –/ Address: Zip Code iTZ ��7 Fax: City: 4 State: Phone No. 722 l6 a 1, 22 15 Zip Code: '��_ �'S Fax: E-Mail: Phone No Fill in fee simple Title Holder on next page(if different E-Mail from the Owner listed above) State or Co ty License rt, If value of construction is 2500 or more,a RECORDED Notice of Commenc ent is required. SIJ'PPL MENTAL CONSTR�IJCT011LIEN LIN3FORI IA1'IQN: 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 commeAcing w rk or recording our Notice of Commencement. U 'J 1i�'U' SignaturetbfOwine Agentntractor Signature of Contractor License Holder STATE OF FLORIDA r� rr - ' STATE OF FLORIDA COUNTY OF JT Z_Q,C k–f—, COUNTY OF The f rgoing instru ent was acknowled ed_§—efore me The forgoing instrument was acknowledged before me this day of 201 by this day of 20_ by \01I (Name efperson acknowle 8g) (Name of person acknowledging) (,477�- /-\P r-1) VD (Signature of Nota ic-State of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identi ' �fa�5 Fp16 ersonally Known OR Produced Identification ProduceType of d Identification 101I.S\a ,�16,P ' pe P rbducelddentification Commission No. Commission No. (Seal) s a REVIEWS FRONT �' oittlSUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.