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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APP: ?.`,CATION TO BE ACCEPTED O r Date: 5-d /`f� Permit Number: 5 0 D D-, a Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 „1 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential 1� PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PRnPOSED iMPR®UEM�ENT L©CATI®N: Address: 110 2, S R4NI/� A � Legal Description: Property Tax ID#: 1301-'142111-0633Q -000 -S-' Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: 14A AJ G2 0 a-t- EL C_A CCA Wet, -To b(-e,�Le ac �WQ e,L. 2,00 o /vp PA,,U e�t-- Q / cucl CO�UST'RUCTION INFORMATION: Additional work to be nertormed under tis permit-check all appy: ❑HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors Electric 0 Plumbing [IS' rinklers 1-1Generator �Roof Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ ;16(g, o Utilities: Sewer Septic Building Height: C`4NTRACTOR: r , Namerfn C_`e Name: nn ` L Address: (SS Sca 6A. U Company:T�y L( 1S tz-L E�4r-i C City: State: s: 2�-6 JS- F_ Co luso clae- Zip Code: Fax: City: f�i E4 LcuGC--. State: 14- Phone No. l -22 11111-O(ILI__5 Zip Code: Fax: Z-72--33 S- t03 E-Mail: Phone No. Z - X37—Ll/ !7 Fill in fee simple Title Holder on next page(if different E-Mail: ho6-tUM 12e LEYI_SO w J�� from the Owner listed above) State or County License: lz-/ 5— If % 5—If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPl.EMENI'AL CONSI RWCTIONI L I N LAW I,NFORMA ION: 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 i pection. I you intend to obtain financing, consult with lender or an attor ey before commencingw, or reco our Notice of Commencement. , Signatur f n e rXess`e_iWAgent Signatur o ntrac r/Li rise Holder STATE OF FLORIDSTATE OF FLORI COUNTY OF COUNTY OF The for ping instr a was acknowledged fore me The forgoing instr t was acknowledgedre me this day of 20�`5 by this�?day of 20 /Jby c0 Q5 aLt i(J/_ ' f3�✓� t '� (Name of person acknowledging) (Name of person acknowledging) \J (Signa o Notary Public-St to of Florida ) (Signature of Notary Public-St of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification` Type of Identification Produced ,����� ° "" DAWN MILDNE Produced ,,�os�ar"�s� DAWN MILONE ay n y ;ublIC-State of Florida c c= Notary Public-State of Florida ' * �. My Comm ' °M% Co ares Mar 22;2017 - :Y- { Mar°22,2017 Commission No. eM? Commission No. ': Commission EE 877571 Com issinn 4 EE 877571 . of v�P,. ` -���'� � Bonded Through National Notar Assn. Bonded Throug•National Notary Assn, y REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 712014