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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE I FO M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED IQ � 0 � Date: � � Permit Number: U nMT s r 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 f. _ PERMIT APPLICATION FOR: PR`t PQSED fN, f�RO0UEM'1NJ-00, Tf®;N: Address: O Legal Description: Property Tax ID#:,3qI I " 0121 —60015 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DE�5CR�IiP�'IQN QF U1/®RK: ,,, ,,; iiiiiii C®'NSl'R�11C1'IC�3lV I�N�F®RN �►TLON: _ XcIclit'lonal work to be pertormed 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: Sq. Ft. of First Floor: Cost of Construction: $ �j , �� Utilities: —Sewer —Septic Building Height: b CONTRA OR Name Nam Address: CDCOIWT aSn Com City: QS I State: Address: Zip Code: J4Fax: City: State: li Phone No. c r"O� Zip Code: Fax: E-Mail: Vi dd - Phone No 0 Fill in fee si I itle Holder on ext page (if different E-Mail fvf 1�r from the Owner listed above) State or Co ty License If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SU PLEMEN L C®NST .UCTi© INFORiMATION: 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 fai ret Record a Notice of Commencement may result in your paying twice for improve nts to your p e . A otice of Commencement must be recorded and posted on the jobsite befo the fir inspec 'o . If u ' tend to obtain financing, consult with lender or an attorney before co mencin ork or; e r u otice of Commencement. Signa ure o Owner)L s e/Agent Signature of Contractor/License Holder STATE OF FLO ,y STATE OF FLORIDA COUNTY OF :� �o) COUNTY OF The for oing instr ent was acknowledged before me The forgoing instrument was acknowledged before me this I day of 20_6 by this day of 20_ by (Name of er n acknowledgin ) (Name of person acknowledging) (Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) Personally Known A `OR,Pro i. Personally Known OR Produced Identification Type of Identi ti—O_��,�ot"�Y --- . AWN MILOIQF— �Type'of Identification Produced 1 Notary Public-State of Florida Produced omm.Expires Mar 22,2017 Commission#EE F571 ?571 Commission No. a 'f-°����`� BondiiNjlghNational NotaryAssn Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.