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HomeMy WebLinkAboutBuilding Permit Application All APPLICAIJLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �y Date: /� Permit Number: w 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 IV PERMIT APPLICATION FOR: # .`� a�k.+„c�. �as ro�aa 5 ac .t 0 P 't . E�D� i1IF'R.OU111 �.„ �LC3GA1ff '� ' qrt Address:' 7 {s►�� /'i�!/G ��- �, ,e L Legal Description: Property Tax ID#: SC/I? - r/6 - GOa 0 QW- 7 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: { t .c�=d'-t� -''„- a,� ae as l'th`£. h r�;r a, Ch.9rrpe cke- A /CL To ((,o .See-f itiona wor to a pe orme un er t is permit-c ec a t at app y: _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: $ Utilities: _Sewer _Septic Building Height: r.:_ �. "Y `¢'S` `y”•+'•' I� �) #17S ";� �i `r' .#+.ria_ tY e ;r 2+1-+ q.:N.r" >;P iki,":a "'"-rs J art" %?�,x'':=, "' 'Y ,#,3 a ,'r,LL i�. e �� R =CSE#SSI* Name6 4.7 Name:-of 1 -u Address: 0-).4' C- je3 Company: City: (��'' S�' �iGGw Statela Address: !(ef s4/ Zip Code: Fax: City: 00 � S �- Ly 4"e Stater Phone No. 772 -'tr.?O Zip Code: 71 q S 3 Fax: E-Mail: Phone No 77.;0— Fill in fee simple.Title Holder on next page (if different E-Mail IOC C&4 !I COO /.gid_p a� � . Gp•-� from the Owner listed above) State or County LicenseC-,9 C-IS'/ 7�0, If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SU PI.Il E: { C.ONSTi tCTI©N L a N w o ATIt 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, 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. ^ - ZZ—', — , -1 ture of wner/Lessee/Agent Si re of Contractor/License Holder STATE OF FLOR19 STATE OF FLORIDA COUNTY OF.J'�' COUNTY OF Qi The fos��r oing instru ent was acknowledged fore me The for,gQing instrya�ent was acknowledged l efore me this l�day of 20 by this /`Z day of L-U 20� by 60 Name of person acknowledging) (Name of person acknowledging) (Signature of Not'ry Publ' -State of Florida) (Signature of Notary y Publi�State of-Florida) Personally Known OR Produced Identification Personally Known � - OR Produced Identification Type of Identification Type of Identification „ ; _._r r, r� . °? Produced Produced , ��-�•"' • l)ArdN lall�,,.tc A . .' _ rY..rU01;C - S` e •'�' e- t� of Florida ' M es M i �. 14`ceM ;b�t2r Stale otr-lorida :. �;•' % �' ,, Commission No. Commission No. r. �� ar 22,2017 ,d, Com x ires Mar 22,2017 ,,F��„;.� Co iss on #EE 877571 Commission#EE&77571 Bonded Through National Notary Assn. Bonded Thiough'tOlUlldl ary ssn. DAW REVIEWS FRONT ZONING SUPER I O PLANS VEGETAT 0 ° t� A l�4drylblic_ 1Q�IfGROVE COUNTER REVIEW REVIEW REVIEW REVIE '.f1LMldim.Exp rsVILVM/ia ;y , DATE issian #EE ThroughN RECEIVED . <PR�PbG., DAWN All_ONE ` ,`m8ondediioral v7i + h,,�r, TE = II �'- ”' a � '1• - Y Comm. Expires�i4 MPLETED =9� y Com u» 71 //2014 Bonded Through National.Notary Assn.. �.: