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HomeMy WebLinkAboutBuilding Permit Application All APPLICA LE�FCI MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 6 © �� Date: 1 S Permit Number. t - *dY^N!r!� 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 _ PERMIT APPLICATION FOR: PROPOSED INPROUEM(ENT LOCATIO Address: Legal Description: PropertyTax ID#: �L\3� '�S��— ��`}l� r� C� " �- Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DfTAULED 011128"R PTI0N ©F WORK: C®NSTRUCTIO' INFORMATION: Additional work to. e peffo-rmed under tis permit—c ec a tat 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: $ I wJ O1 Utilities: —Sewer _Septic Building Height: QWNER�LE=�S�SEEv� COMFTI AC1"OR: Name , `:` +eC,�s�;� Name: Address: oZ�� l �l�,�r' Company: City: c Stater Address: L>> Sal R �V��,���er✓ Zip Code: Fax: City: PSL Stater Phone No. -)-):2 -(aV k-�8 )-- Zip Code: Fax: 77a E-Mail: Phone No -)')a- Sam- )SOL Fill in fee simple Title Holder on next page (if different E-Mail T—N sckl T° YbNW 161101", from the Owner listed above) State or County License ip 9 4 3S If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SR0.1010,MENT L CONSTRJCTION LIEN LAW INFORMATION. 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 th st inspection. If you intend to obtain financing, consult with lender or an attorney before comme cin tcorcling your Notice of Commencement. Signatu 'f ner/LORID Lessee/Agent Signature or icense Holder STATE STATE O A COUNTY OFCOUNTY OF The forgoing instru t was acknowledged before me The fo_rgping instru nt was acknowledge efore me this-M—day of A5 by this day of 20'('_ by '\A� S' I Ad L-PA 1A_ (Nam person acknowledging) (Na of person acknowledging) J ( i a ure of Notary Publi t to of Florida) _NE `0c�aa (Signa ure of Notary Public-S to f Florida) Personally Known OR Produced � a� e 22 `�Rersonally Known OR Produced �pao��,l;da Type of Identification Qoe"° �c°S�E0 3PSS Type of Identification X010.S�a�e '� 2251� Produced o�aN �Q� � a�N°�a` ° Produced ob��C . SVNa� m� �, �°�o,�` Commission No. 9° <- (S Commission Commission No. '�'irATE OF•`1� �'i`rTq 1.�C` V°�`;w': '1111 11111 REVIEWS FRONT 9"' NING SUPERVISOR PLANS VEGETATIO EA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.7/2014