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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: ©�I / IS Permit Number: 0 Va-VOCLAW, 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 IM-RD INP :4VIMENT LOCAT ON Address: / 70 7 t1l �3 7 S� Legal Description: Property Tax ID#: `• �( • �2• ®�� _ Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back:_��Right Side: Left Side: =AMPED, DE��CR�IPTION OF 1AIORK: en C /0-5(,Ire SCJ/ 52/� P!�r!Zl r9 Imo► CONSTR�U TIO. hN!FORMATI®N: Additional wor to be pertormed un er t is permit–check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _ Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: /0,X Iy Sq. Ft. of First Floor: Cost of Construction:$ 600, 00 Utilities: —Sewer —Septic Building Height: NER/LEaSSEE: CO' RA i•OR: e Name Name:,' ,.fr��'c i'�-, C et r--1-C r- Address: 1 70)7 2 7 5 Company: -i �f�+ City: f. !D�'�l'G State: FL_ Address:.� +e�V e .. Zip Code: v �! 7 Fax: City: QIrr: State:FL Phone No. 771- 2/6 'a7 d'g Zip Code: 3Lfi '1 Fax: 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. I SUPPLEMENT L CONSTRUCTION LhEN I,AW INFOR+MAI'ION. 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. Signature of Owner/Lessee/Agent Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF SSI' COUNTY OF The forgoing instr ment was acknowledged efore me The forgoing instrument was acknowledged before me this I$ day of 20_ by this day of 20_ by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida ) Personally Know OR Produced Identification Personally Known OR Produced Identification Type of Identification AIL Type of Identification Produced a Produced �� SHAHNA INGRAM o�Par nuB` /' Commission No. ;_. .�: NotarybliR State of Florida Commission No. (Seal) _.„ ,•;My Com O ares Dec 20,2018 Commission #FF 177249 O\ mgop,Notary Assn. REVIEWS FR ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 7/2014