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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: �! ��/�� Permit Number: / �� 9 F' _ - - - 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 V-11" PERMIT APPLICATION FOR: PRC"?Pr�SED LN ROVEMENT LflCAnTIC?N: Address: l 0 6? A 3 /'it e- N e (�,J e Legal Description: Property Tax ID#: 30L l 9-0 a D 0 0 Cc? D 0 ca (3, Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: Df � ILED DE�S�RIPTtON �'F W©RK: 14 /ey'e l lZeajr -y�o / Arae r- Additional work to be performed under this permit-check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors Electric _Plumbing _Sprinklers _Generator �oof Total Sq. Ft of Construction: / 4`D Sq. Ft.of First Floor: Cost of Construction:$ 42?'7'19>a Utilities: —Sewer Septic Building Height: OWNER/LESSEE: CONTRACT{+?R: Name �� ,��rJD �c�s Name: ,�lovp7,,4 KL��o✓A Address: company :yl gfg -d✓o¢ ejrrs-�C-6 v---!�Z City: �Z State:_ Address:`:`/'?­1 r arc < .� ..1 Zip Code: 3 �:I j'� Fax: City: State:/T- ;1,V No �3 7d . / �� Zip,Gode::- '3 J�i��Z Fax: E-Mail: Phone No 7 7 ^�iyd-GGs/ Fill in fee simple Title Holder on next page (if different E-Mail from the Owner listed above) State or County License CCC 3R 7a ya If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. DRUMENl'AL CONSTRUCTIO.211 IEN LAW IN ©RMATI®N: 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 commepetrog work or recorclik your Notice of Commencement. Signat a of Owner/Lessee/Agent Sign re of Contractor License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF `� L(A C It p COUNTY OF S7— L,1 C(L The forgoing instrument was acknowledge fore me The f oing instrument was acknowledged before me this day of _ 20/ by thisy�day of 20�y 4, (Name of -erson acknow edging) ( ame o erson acknowledging) Z22 Z,� i (Signature of Notary Public- tate of Florida) _,(,Signature of Notary Pu, lic-State of-Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of(dent' do Type of Identificaon � Produced ° .4J Z_ Produced IfL Commission No. (Seal) DAWN MILONE ; C mission No. Po Notary Public-State of Flo Ida Pa '`' N y + �•'c'% Notify Public•Stain t d, Mv Comm.Expires Mar 22, 017 * + lil 9 x. L •„� �; Co nmission�+EE 8775 1 iP NS VEGETATIO ` mm s,•,4 � a REVIEWS FRONT •�`It�i'iVGBonde TErh�Pri�t14�181�dry Ass �U�tT�e�d r,,,YVIAKIGROVEi COUNTE IEW REVIEW REVI,EWW,_AssP DATE RECEIVED DATE COMPLETED Rev. 7/2014