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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: 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 INPROWEME T L©CATI1M Address: Legal Description: Let Cc- ol- J'v r Property Tax ID#: / - 0-8 -- C3 vSD C>O <0 Lot No. Site Plan Name: zf Block No. Project Name: c�aJ ` Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: C©NSTRIJCTI©N INFORMATION: 0 1 J'J'J I I I I adItional work to be pe rmed under tis permit-check all that appy: _zlectric nical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ Utilities: —Sewer _Septic Building Height: OWNER�LE�S�SEE: CONTRACTOR: Name lA✓ Name: Address: CO A"'­� Company City: 9 A: eJ State: /IJ Address: _o &C 2 2L Zip Coder I I Fax: City: -0zr--�c_ State-t&— Phone No. /` Zip Code: .3 4rt7VX&> Fax: 7--2-,v:- E-Mail: - Phone No ?-- Z 2, - &= c/ Fill in fee simple Title Holder on next page (if different E-MaiC;J:KC3WCJ from the Owner listed above) State or County License G��7 if value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEME 'TAIL CONS RUCTION L N LAW INFORMATI®N: 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, l do hereby agree that I will, in all (espects,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 corp4nencing work or recording our Notice of Commencem t. gnature of Owner/Lessee/Agent S' ature of Contractor/License Holder STATE OF FLORI STATE OF FLORID C COUNTY OF COUNTY OF The for ing instru nt was acknowledged before me The IfVoidrnag instru t was acknowledgbPfore me this day of 20 f_by thisy of 20 by (Na o person acknowledging) TNaoperson acknowledging) INA au An (Sign Notary Public-Stat of Florida) re of Notary Public-Stak of Florida) Personally Known z rd e Id nt'fication Personally Known R Produced Identification Type of Identifi atio J Type of Identificati n J� ;.°��a�; '% DAWN MILONE Produced IL 1 \ = Notar Public Produced Y State of Florida �,�, Dq�yN x. My Comm. Exp; .s Mar 22,2017 t O'arY Pu MILONE " Commission No. '.�=- -t C(> �);t��, < EE 877571 Commission No. =,w. t ( � )c State o '• �"` Bonded Through Nahona;-Notary Assn. ' °� �oir1, Pir(c is t Florida � —e Bonded?n. ;;nom#E? r22,2017 �_ +rio"al Nota, REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE $Y . COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 7/2014