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HomeMy WebLinkAbout%(Field.Code Permit Doc Type ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: �S ' / Permit Number: gApplication Buildin Permit 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: To Select from dropbox, click arrow at the end of line PR(�3R®S;ED IMPROUEMNT L©CATI©N• , Address: v Legal Description: Property Tax ID#: '" Lot No. Site Plan Name: Zvi , Block No. Project Name: Setbacks Front Back: Right Side: Left Side: D`ETAI���ED D�E�SCRI!P'TIOk �, '`AMRiK; C®#NSTRl1CTl®N 111.11Wall Additionalwor tobenertormed under this permit—check all appy: HVAC Gas Tank ❑Gas Piping Shutters ❑Windows/Doors Electric ❑ Plumbing Sprinklers Generator Roof Total Sq. Ft of Construction:)J S Ft.of First Floor: Costbf Construction:$ /�- 5� Utilities:Sewer Septic Building Height: :OWNER%LE S,EE C®NTRACTOR: F Name. / `�� Name: oo Addre ell 'Company,; Cit IL State: Address:'' _' Zip Code Fax: City:, State: Phone No. Zip,Cod:e'.': =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 County License: If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. ME SIlP`PI.NEy�MyENTA,L C®NSTR'lJ BION LIEN !�#UV IN ®R11/IAI"I,ON 'dy]`0.1tih. �>a�nx ±G'.y' "3 .:Y ';'R. �,x�. E' S. Y i$:,X.'Y,':t %fi rl z`'l.r.v.5."t v _ DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:f m Not Applicable F 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: 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 plal 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 wo r recording our Notice of Commence s Signature o O er/L sse ge Signature of Co tractor Lic s Holder STATE OF O IDA STATELF FL RID& COUNTY OF COUN Wit. Q Thef oing ins ment was acknowledged before me The rgoing instrument was acknowledged before me this day o 20 kS by thisI day of 7Z:�.Z__ 20 K by (Name of pers64 acknowledgi ) (Name of personl6knowlel (Signature of Notary Public-Stab of Florida) (Signature'ofNotaryPubti -State of Florida) Personally Know OR Produced Identification Personally Know OR Produced Identification Type of Identification Produced Type of Identification Produ ,ASHAHNA ING Commission No. ••`t.•""n�'' ( HNA INGRAM Commission No. 1_* s`c Noy public-State of Morid • Notary Public-State of Florida ' • My Comm.Ex ilpires Dec 20,20 f f 'N• ' My Comm- '%v "oP of F1 7249 %�fF P`�•• riommlSS10 � Bonded of Foo n#FF 177249 through Nationai:Votary Assn Revised 07/15/2. '""""'� Bonded through National Notary Assn. REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS