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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: 1�G 1,J RECEIV�D JUN 2 3 IM 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 dropbox, click arrow at the end of line PROPOSEb UP MENT. Address: 211<3' IG` 't (7 re-,jee, 22.ria r- /,,e7ha ef;2�, oc� 3-'12qo Legal Description: Property Tax ID#: 4(41_42�-7 01 00!4/z —C2 On Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: 1 'Al" DESCRI -OFVoRk- 5U UO... N t)4L pcL- Q00STROOON (NOOR MA ON T1 Additional Work to be e orrned unclertispeiim� check all that apply: L 0HVAC Gas Tank E]Gas Piping Shutters F]Windows/Doors Chlectric Plumbing 05priinkiers [lenerator 11 Roof Total Sq.Ft of Construction: S . f First Floor: Cost of Construction: Uti.lities:cnSewerFleptic Building Height: TOR AC Ft/ -R Name-16hA, Name: Address:2019 NW t -fenbrkr 4Company: 'S L4-J, P.4-k city: R- ., "-,, State: , Address: j? G' 5�,ie- 76�Sr Zip Code: 3Y!79� Fax: city: Rrl- _,:5a8 r Vlf, State: Irl- PhoneNo. gy -22 7-.2, 3 - 7 ZipCode: 341?V2 Fax: 772 E-Mail: Phone No..7�-Z 26' -.Z.-r`fff Fill in fee simple Title Holder on next page(if different E-Mail: 11?1 0 kye_ Wo. from the Owner listed 'above) State or County License: r4 If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required. Oul 'buiqwnld }Md q1noS P_l,l,:Z L 00 OZ jdV UPPLEMEi` A� D�iSTRU�fiON LIEN-LAW INFtaRli/fATIQN` wiz tz { `�'yr fi �v,a ,t" s.. . f..w ... ....{-.r..wsn.:...i.�-w..t.4`'^x.;1... .. .. ... :.. .:...: ... :... 1 a...:-4s ��� �.Si�SR� ..ti F'�`�"'•� "�'',}t.�h• 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: I certify that no work or installation has commenced prior to the issuance of a permit. St.Lucie Count 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 usesto 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 Commencement. y _ LM Signature of Owner/Lessee/Agent^ Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA '3 COUNTY OF ! �'� i COUNTY OF � .,Ei The fppgoing instrument was acknowledged before me The fo going instrunrnt was acknowledged_before me ! this day of ,.r`;�� 20 L'�by this I day of C 20 . y (Name a rso acknowledging) .J (Name of er on knowledging) , (Signature of Notary Public-S to of Fior at 9�y$� .�y (Signature of Notary Public-Sate of Florida Personally Known (>/ OR Produced ide 'it{i3ti( Personally Known V OR Produced identi Type of Identification Produced Z Type of identification Produced { ON Commission No. (Seal) 1 Commission No. (Seal) •Q cr m Revised 0711512014 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS £d 699Z-L9Z(ZLL) ouI q id�i'but Nan ae dulno3 e6VZ100©Zadb'