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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r Date: / J Permit Number: Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 r Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: M r,eA i, n�I s:: }+,jz as s�•��6„has- x.: ��� i oa,i t. € �.er. �j:aw w, r ,�... .��r:` t w�ua .. zk ar s� sL I `� +, tl a F air { Y- ,� er ` quiff �F'R PC}SEDI,NRtJUE11lIENTLOCAa �. � � . Address: �C�Cd l-L.� tyl Legal Description: Property Tax ID#: �� �-f ®� Q Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: :t,`,.�-..taa6 y::Frit�� aa- ,zc,u CRTCF.: uFh1( ` .r,a.s �s fit I® UDRK +i11,,mAxFx dD D§ V . -17 u401c" ([ V . 4z.;s.4 itqAc `^° z0a,704 " �? Acid tional work to be pertormed under this permit-check alt at appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors X�lectric _Plumbing _Sprinklers _Generator _Roof J Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ � � � Utilities: —Sewer _Septic Building Height: :'{� 9�`M' T g 'r 'rNY•h :. sYr �iYd r},Yy !w +�IC+ + - Y ii s r`�r�r' " v yWERjLESS 6 p£ !wr S CONTRACTR�; , ter.x, Nam' s ; Name: ��fl Address: .<-36-7 {� OW- Witi, Company: aS " CeC/ , City: State: Address: Zip Code: Fax: City: 1 ,Pln Stater Phone No. 77 ( � ' ©� ° Zip Code: f�� Fax: E-Mail: Phone No (;7- Fill in fee simple Title Holder on next page (if different E-Mail CSS [l,ti r !G f o lJ" from the Owner listed above) State or County Licensel �� C`t If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. ark. +Ga r,Pt ar,„4'� SU°PPLEME-NTA�coNs FtucT�oN �1 �N iAw I oRN4AR-rloN� kix �x IX 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 or recording our Notice of Commencement. Signature of Owner/Lessee/Agent Signature of Contractor/License Holder STATE OF FLORID RI )+ STATE OF FLOD - COUNTY OF � �' COUNTY OF The f9going instr� ent as acknowledge before me The forgoing instr ent as acknowledged before me this day of 20ZL—?by this day of 20r\ by o_ " (Name of person acknowledging) (Name of person acknowledging) s (Signature of Notary Public-State 0 �t Spate ON 22 20N ("Signature o Notary Public-State of Floridan . Personally Known ,Qf�Prc{�b>�Le�¢�F1g��t��� v SSn�• Personally Known OR tNil�ro Type of Ident' i ti .��Pp�eve`' %,N,y °�`mtss`0"Na�,ona�� Type of Identifi a i „ public-State Produced ' • °mthcou0� Produced `•,"._, �;� Notary :-40ves M,a<22,12t %� o��� eo° :_; •: Y' #EE 8751 °; •. .tee_ Commis ° Tonal NotaY A ' Commission No. (Seal) Commission No. :s::. gondedTh� REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Re—v.7/2014