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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 3 —i S`-' Permit Number: MR Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34952 Phone: (772)462-1553 Fax: (772)462-1578 Commercial esidential 'PERMIT APPLICATION FOR: PR flSED 1 PRQA% ,'� LC3C�1���wl �. � °� �° w�� � �... ��.�5 41 n. Address: Z j Y C Legal Description: Property Tax ID#: 5 4 2-4 2 ®.3 6 ©do Lot No. 2(� Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: V CrvP1�_4j rr — i C(}ISTRl1CTiGN l�fF®R1VA,TItJNyn itiona wor to a pe Orme un er t is permit-*c ec a t at app y: �. _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:$ /(D//O 0 Utilities: _Sewer _Septic Building Height: � � ,1r(NSR LESSE � a 2$'1 Tl�M� C Nl'RA Of • , t �ak � ; =,_ Named Na'me''` Address: 3��3= SGS�12Xsx� e Company: o-9 A p,c1 C City: S State: Address: Zip Fax: 34 n i i& City: e5 State- g 4 q8' Phone No. Zip Code: Fa/x: �Ll, o �6 1{ E-Mail: Phone No �� 6 6 Fill in fee simple Title Holder on next page(if different _ E-Mail 0S ke �x PC from the Owner listed above) State or County License C D.l If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEIUIENTAL C©NSTR«UCTION LIEN LAW INF©RMATION: 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 9r,recording our Notice of Commencement. g ature of Own essee/A SignatureO of on ractor/License Holder STATE OF FLORID - STATE LORIDA STATE OF FLORID COUNTY OF COUNTY OF The forgoing inst ument was acknowledged before me The forgoing in ument was acknowledged before me this�day of 20��y this� day of 20�by V.J_�_ ), (Nam f person acknowledging) (Name o erson acknowledging) (Signature o Notary Public-State of Flo ' a) (Signature of Notary Public-State of Florida) Personally Known a 'o Personally Known wOftRrAdt; eddldentica�iori "'�"" N Type of Iden if cati ,.1pNV i:' DAWN MIL'uf:[. Type of Id f c ot►R�P:��+, DAWN MILONE Produced a otltry Public-State of Florida Votary Public-State ofJ27. Produced ?2°y ��'' =`,,; . ._ _r. o Aires Mar 2 y omm.Expires Mar 22;2017 = ` �° Commis n E 87 Commission No. ;'EOFF� Comm EE 877571 Commission No. �;jF G,�°" � anded Through National Notary Assn. onded Throu al Not REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.