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HomeMy WebLinkAboutRevised Permit Application (2) All APPLICABLE INFO.MUST-BE COMPLETED FOR APPLICATION TO BE ACCEPTED l Date: Permit Number: 1 ii 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: Address: 1 I �l JT�1V A c� l1� C I Legal Description: Property Tax ID#: 3LI I Cti - J C. ® 033" - 000 - c Lot No. c�/J Site Plan Name,: ` e.t c" Block No. J 7 Project Name: Setbacks Front Back: Right Side: Left Side: 1111M S LC V'), G@. .0-n G `i. "+0. 11 A I 15 7 C1= P h . LA/ 10. i ` 1 Ex,rnZ� tttona wor to a pe Orme un er t is permit-checK all that appy: Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors rTota1S .,Electric Plumbing Sprinklers Generator Roof q ,Ft of Construction: Sq. Ft.of First Floor: of Construction:$ b©' Utilities: _Sewer Septic Building Height: Emil Name o p ok 1�) Name: ' rZZ Address: )14 S.& - YN c�, Company-(__)o"J Gr-e. .' al eAp"c C L C, _ City-'a, SA• cu c k c. State: Address: ?300 G , / 5-f qreej Zip Code: '?Q `i' Fax: City: r tr e, State: �_L / ' Phone No.� � Zip Code: Fax: E-Mail: cai r� ec. c, �_G rt Phone No Fill in fee simple Title Holder on next page(if different E-Mail C40 P+(;;!`t.e n 1 Ic c ft's Qc 4m.'L.:Lad Yrr from the Owner listed above) State or County License 2/, O'4'aa If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. 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 be first inspection. If you intend to obtain financing, consult with lender or an attorney before com enc ng work or recording our Notice of Commenceme 0Z )a z i 44 Signature of Own r/Lessee/Agent Signature of Contr ctor/License Hol er STATE OF FLOR STATE OF FLORIDA N COUNTY-OF COUNTY OF 12 N iFt a The fp ming ins nt was acknowledggd r r1� The forgoing in ru as acknowledged befo this f da -of 20/ tiN= this /�—da o 20_ b r'`. . Y Jam_day L Y U a Q mod:9 W w '✓ c Name of person acknowledging) �} (Name of person acknowledging) a x W m g off" o• Signature of VrVPublic7State of Florida g, ,o (Signature'of Not Public-State of Florida) - Personally Known/OR Produced Ide i Personally Known OR Produced Identification: Type of Identification Type of Identification Produced Produced Commission No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW _ REVIEW DATE RECEIVED DATE COMPLETED ev.