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HomeMy WebLinkAboutBuilding Permit Application -71�o ALL APPLICABI, INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 11 Date: Permit Number: 160 Q0 • ©1-2 aj J x 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: To Select from drepbox, click arrow at the end of line "PROPOSED'.IMP0VEMENT LOCATION Address: k, — �l Legal Description: %Property Tax.ID#:%_110_T(ba-,8(12t_nCx)-9 Lot No. Site Plan Name: Block No. . Project Name: 1 Q.0 QS� CeS�. Setbacks Front Back: Right Side: Left Side: 41 �DgET ED DESCRIPTION OF WORK + `n�12C U� OC� ("'NA-A-0 !!!jjj1� iS�.R�.o� l� 2a 11v �_Q_W (j\ A,�,ga\ves J �� C'ONSTRllCTION'INFO , MATION „ fix 'Additionalworkto e e orme under this permit—c ec a appy: E1HVAC Ej Gas Tank Gas Piping _Shutters Q Windows/Doors-_ ElElectric \[Vlumbing Sprinklers FiGenerator Roof Total Sq. Ft of Construction: SFt.of First Floor: a Cost of Construction:$ o�o��C)d� Utilities: _Sewer 0Septic Building Height: 0111%NER` SSkFT f .}ON;TRACTOR . Name Name: Ad ss: L _ Company:'�Gul°,� City. State: VL AddressAkz)F� &.P[�d -R\g'1. - Zip Code: Fax: Cit City ��f'zKA (t. e,%t _ State:�L Phone Nona—,Rr1� —S taU.O Zip Code,�(Aq Fax: E-Mail:S\Pa\%O� Qs'1jYyj'A ,QQYV% Phone\No-.11a -2iy` -g4� Fill in fee simple Title Holder on next page(if different E-Mail.Ylc"AAa 1 41,ACA C0M from the Owner listed above) State or County License: If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPRLEMENTAL GONSTRIJCTI 6N LIEN LAW INF h& 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: 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 or recording our Notice of Commencemen AG, s _Signature of Owner Lessee/Agent Signature ntractor/License Holder 1 STATE OF FLORIDA STATE OF FLORIDAr I COUNTY OF COUNTY OF Lx-,4�_ The fo oing instrument was acknowledged before me The forgging in ent was acknowledged before me this day of 20 by this�day of 20 J by (1,AW6,6 A '1'eo, ('R&11- L� -U� IA (Name o rson acknowledging) (Name of person acknowledging) i (Signature of Notary Pub[ -S .a) (Signature of Notary.P _Stat of Florida) Personally Known OR Pr uce�e},I�en ion Personally Known � OR Produced Identification Type of Identification Produced to O� Type of Identification Produced ^� Commission No. ���cf'i0 �� Commission No. �� J o1c1 / (Seal) ISH®HIDA LAI"FERTY V MY COMMISSION#EE854297 Revised 07/15/2014 iEXPIRES January 08,2017 3 RoNaN2MServicO.COM REVIEWS FRONT ZONING SU ERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS