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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: ! �� Permit Number: w �� 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: PR©POSED INPRCR3VEMENT L!CATION: Address: 03 Un Legal Description: Property Tax ID#: Ian ll ._ (,05 r (53� 600^ Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: Dfl'AILED F ifEDSCRIWTI fl, N OF WORK: 0 ©c�� -Ptk-- S CONSTRUCTION INFORMATION: Additional work to be pertormed under this permit-7check all that appy: _Mechanical Gas Tank _Gas Piping —Shutters _Windows/Doors •Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ _ ()•�® Utilities: _Sewer _Septic Building Height: Ol;WiNER/LEaS�S,E�• ' CONTRACT ®R: Name '(f G U Name: Address: Company: !me),z� ­:�i2 alau City: StateC Address.- Zip Code: Fax. City: < State: Phone No. ��=C2 ( L2 7 Zip Code: Fz x: E-Mail: Phone No �– Fill in fee simple Title Holder on next page (if different E-Mail from the Owner listed above) State or County License If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. S�IJiP'PLElUIENT'AL CONSI"RjIJCI't®N LEEN IAUV INE®RMATION: 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 ,,n– er n attorney before commencingwon or our N ice of Commencemen _X Signature of Owner nt- Sikftafure of Contrac r/Li nse Holder STATE OF FLORI�'`.J/1 � r STATE OF FLORIDA � -}- COUNTY OF �1� COUNTY OF ,_ The forgoing instr nt as acknowledge 6fore me The for oing inst a was acknowledPPe fore me this 31 day of 20 by this day of 20[ by 0 q(Ivmiln�. _)l . - J , cA ame of person acknredging) (Name of person ac ledging) ��, A)1_�_ ff&�_ -_Ah6.,T (Signature of Notary Pu blic- a of Florida) (Signature of Notary Public- tate of Florida ) Personally Known Produced Identification Personally Known . OR Produced Identification Type of Identification Type of Identification ProducedAIN �DNE Produced State of`Florida DAWN MILONE a ,P"Y'r Notary 2017 ���� ,, Public- ��i�av rs'., r� t Flc,da Commission N_E N Expires r(l3 Commission No. o Notary Public-(��alt 87771 ^i `• 22.2017 Commission EE y Assn. .. ?My Comm.Expires A- ' ' 4i '�`: Commission #EE 877571 Q; ational Notar r., Bonded roug REVIEWS 11146-Pr' ZONING SUPERVISOR PLANS VEG S' T E MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Te—v—.7/2014