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HomeMy WebLinkAboutBuilding Permit Application (2) SkJPPLEME IAL COUSN, N LAW I P1,01—K-01— M__ —M F®RMATIt�}N: DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: Address: Address: City:- State: City: State: Zip: Phone Zip: Phone: FEE SIMPV TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable Name: Uu S Al^ � Name: ser 0,01 _0/s v �c r Address: Address: City: c.. City: Zip: 33 vee& Phone: Sz 73 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. Xgnature of Owner/Lessee/Agent N ` sioture of Contractor/License Holder STATE OF FLORISTATE OF FLORIDA ¢^N COUNTY OF i.2; COUNTY OF _5'�4 C Cd b =o maa. The for ping ins m was acknowledged befo rp 2 The forgoing inst m t was acknowledged befor R ja fflo this day of Linnnell 20 by aX this day of 20, by g��2 �w o ¢OX 0 m �4lJ a ( ame of person acknowledging) r btu (Name of person acknowledging) (Signature of No ry Public-State of Flori a) Signature of tary Public-State of Florida) Personally Known OR Produced Identification 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. /2014 All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: �J Permit Number: DECEIVED ® _ Building Permit Application Planning and Development Services JUL 16 2015 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: P �OPOSED IiNPR®DEMENT LOCATIO�1: Address: '5—..30 D c{a C`, K S gw"-1 Legal Description: Ae Property Tax ID#: Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DE AILED DESCRIPTION OF WOR+K:. De 4-Z y' P�Gv cJ 2 /'1-1-e Z z__ f %1 Q!/1 G� CQNSTRUCTfC1N INF©RMATION: Add itiona work to be pe rtormed under this permit–check all that appy: _Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: 3 a®-v Sq. Ft.of First Floor: �, v 6 Cost of Construction:$ Utilities: —Sewer _Septic Building Height: ODU!NER/LE�S�SEE C®NTRA 0'R: Name �74, t Name• o Gt� Address: �C,/ ,L�,G � Company: b Li u �Co h ,�o // C_ City:ze� ?� ��l-�c� ��Q lo_ Stater Address: //DUBS–" GlJ 7 ,� Zip Code2> 3V0 CP Fax: City:--It 2a1_< State: G Phone No. 2l el—S� 3 Zip Code: 3 P1514 ' Fax: E-Mail: Phone No 77.2 – 3 ] Fill in fee simple Title Holder on next page(if different E-Mail Ja 4 k o Z­d bP from the Owner listed above) State or County License a=-- If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.