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HomeMy WebLinkAboutBuilding Permit Application (4) All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: q– 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: RRIPaSE/D INPRC)WEMENT M9.0.01 I M MR. Address: Legal Description: Property Tax ID#: G},��� t) Z�®���,�('� Lot No. Site Plan Name: Block No. Project Name: �F _G{ ar:& l J-c. 10 Setbacks Front Back: Right Side: Left Side: DE AILED D£�S`�R P 1`ON OF 1NOR1�: C©f STRUC«TI®N I'1NFORJffl ON: Aaditional work to be pertormed under this permit–check all that 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:$ Utilities: —Sewer —Septic Building Height: OU,1/N1ER/ 1-12,031 CONTRACTOR: Name /O dUW(tie4 FName: Address: qooL a" r Company: LUn-- 04V t( City: State: Address: At Zip Code: Fax: City: jT�}_ �_ State: Phone No. Zip Code: :S 72 Fax: E-Mail: Phone No--"5Z z Fill in fee simple Title Holder on next page(if different E-Mail �( from the Owner listed above) State or County LicenseL 4 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLE11ilENTAL CONSTFt+l1C1'I©N LIEN LAW I I=ORMATIaN: 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"Ass.ociation 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,ofCommencement 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 Ownent _ Signature-of Con cto a Holder, . STATE OF FLOVDA STATE OF FLORIDA COUNTY OF COUNTY OF Theforgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this oZ day of f' 20_ by this zK day of_'SQ adz 20_ by F7 Wali (Name of person acknowledging) (Name of person acknowledging) ignature of Notary Public-St to of Florida) (Signature of Notary Public-St to of Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced Commission No. (Seal) Commission No. (Seal)• ' REVIEWS ..FRONT ZONING ' SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE- RECEIVED.- = - - DATE COMPLETED ev.