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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: a e 1T ~ .I 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: To Select from dropbox, click arrow at the end of line P ®POSED IMI EEME: LOCATION: Address: 1 I Z t'i o2y+L A Legal Description: Property Tax ID#: ( 3 12--1c> t r)n 13 ©oo`7 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: ID: I��ILED�D"��SR+IPTIa'N � ''O`R�IC: AJd ins Gvik d ou6l(z sa)e Qv\ r��b.� s i Rd«i'v)'5 oiU St'v,51e ga° e +o �6 l e�+ S i'c1 Q q,"d cwto. % h -lu c(2 vA 0_ r bac � YOd, CONSTRUCTION INFORM TION: Additional work to be nerformed under t ispermit-check all appy: L_ HVAC J Gas Tank E]Gas Piping _Shutters Q Windows/Doors 11 Electric 1:1 Plumbing ❑Sprinklers El Generator FIRoof Total Sq. Ft of Construction: SFt.of First Floor: Cost of Construction:$ (j� �C Utilities:i Sewer E]Septic Building Height: 0�,WiN,ER/LESSEE:; CO.NuTRACI'tO�R: Name tr Name: Address: I Company:_ F City: l^�, �,,P r c p State: . ,Address: Zip Code:_3�11 15 1 Fax:_lu City:`"_ State: Phone No. -T7 7 - rS 3 - l 4 15a Zip Code: Fax: E-Mail: 4`nor',,<hvi, 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. SUPPLEM'ENTALCaNSTRUCfI®N LEEN LA,W I1N.F®RMATI'©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: 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 thepermit 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. I At'IAAIA '8 bd�,AAa' s _Signature of Owner/Lessee/Agent Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day c, 20 ) by this day of 20 by i (Name of person acknowledging) (Name of person acknowledging) C (Signature of Notary Pu 'c-State of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Produced Type of Identification Produced 1�L ►5-�•{�L1lpa.•�93• �• t3'1.O Commission No. m ;, . S ssion No. (Seal) LASHAHNA INGR M Motary Public-State ol Florida • My Comm.Expires Dec 20,2018 Revised 07/15/2014 ="r' a:= Commission#FF 177249 a '��,,,,,��• Bonded through Nations'Notary Assn.t? REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS '.. r it b Y I earth feell 1100 meters 30 GLJtc` 0c e6 e�e�e toys ,Gac��ray�e6`�'��r`�ot�