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Home My WebLink AboutBuilding Permit Application All APPLICABLE INFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _ Date: v� i �-aJ Permit Number: As d`�7 092q ffim i�tlw N..' etifA^Fpc - _ 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: PROPOSED 1'N ROVEMENTLDCATIO,N: Address: igtF-F 6AKEM tAm.kWM F lam FL_ 34151 Legal Description: Property Tax ID#: 7- Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETA)LE® DE�SGR�I�PTION ©F WORK: Cg4t IM6 OUT �:LE-CT1:lc NSR CAN - FPL Hs To1owz 6Y%: Mr� PPP GVE-0 JM 0099, 16 D�V,6 To c+AN661- OUT M`E�-TeK c.AJ\1 CONSTR'UCTfO'N INFORMATION: Ad d itiona I wo rk to a pe FForme un er th is permit-check a I I th at appy: echanical —Gas Tank —Gas Piping —Shutters —Windows/Doors v Electric Plumbing Sprinklers Generator Roof — — g — p — — Total Sq. Ft of Construction: > Sq. Ft.of First Floor: Cost of Construction.$ -1""`w Utilities: —Sewer —Septic Building Height: OWNER/LEaS�SEE: CONTRACTOR: Name omy .,Name: le '7529 Rv, Address: � >S � ��. Company: City: i0ZLEState: FL Address: D I� Zip Code: Fax: f City: . P�H�E State: Phone No. -(M214�5 Zip Code: 34-95 Fax: E-Mail: Phone Nom �(77Z) 579-9 " Fill in fee simple Title Holder on next page (if different E-Mail � v5r%D )1955a ymoo. o)-i from the Owner listed above) State or County License U`p)30 !SL-(-- Z9MO If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. S°111PPLENIEN 1131 1211 / I�NF�RNIATfCIN: 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. "%%� 4&f*W&z__> Signatu I PAW Lessee/Agent Sign atur ntrh ctor/License Holder STATE OF FLORIDA )� �� STATE OF FLORIDA f t COUNTY OF l COUNTY OF Theoing instru ent wa know edged b re me The f rgoing inst ument w acknowledg a me this day of 20 y this lay of 20 by (Name of person acknowl dging) (Name of person ack ry le ging) 6' l (Signature of No ry Public-State of Florida) (Signature of Notar Public-State of Florida) Personally Known OR Produced Identification wn OR Produced Identification Type of Identification ;4o" ;pf Identi c Produced �� ;• tEce�tBly Punir A =y,� ao� CommissionT#FF o1 Florida Com A: ANGELA N1 HUFF �c�� ''•,;fit$nim i POOE 234730 (Seal) vP��%: Notary Public #FF 23473m0ndedthroughNationalNotar A019 commission Y ssn. ,� My comm.Exp res May REVI V��;, ;,;