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HomeMy WebLinkAboutBuilding Permit Application All APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: f'0 Permit Number: IL>----i' � 04 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 INiBMIMI IIN LOCATIl3N: Address: 0 &it r c.,k, !� � y C Legal Description: 1_3C � 2 � 69� Property Tax ID#: Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILS© DE�SC IPTi®N D N"rkto" Pppr-t-o--rmed 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:$ e5_5�60 Utilities: —Sewer —Septic Building Height: ©V1i'�ER jLE�S�SE�E: CONTRACTOR: Name -ri ' Name: .VC Address: .J E: 1 Company: City: State) Address: Zip Code: 3 L19k ?_ Fax: City: SL State: Phone No. Zip Code: -3LfqR 2 Fax: E-Mail: Phone No 7 .�- o�/- Fill in fee simple Title Holder on next page (if different E-Mail .2, from the Owner listed above) State or County License_ If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUP'PLEMENTAI CQNSTR CTION I LIEN RWA 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, 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 o recording our Notice of Commencement. Signature of Ow er/Lessee A en t Sign ure of Contr ctor/Licens H STATE OF LORIDA STATE OF FLORIDA COUNTY OF oo COUNTY OF Ssz The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this'�> day o 20 by this 3 dday of Z t 20 15 by L> C\ (Name of person acknowledge ) (Na a of person acknowledging) f§igi4ature of Notary Public---State of FloridaJ_S_i6atiAre of Notary Public-St t 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. ,. RAM LASHA State of Florida ,•`otPa °B� •, Notary Public gn 018 •: ; My OMM.rA i # F 177249 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGE f�FFo EAS alio a1�i OVE COUNTER REVIEW REVIEW REVIEW REVI:�J''",,,,,,�'` s >� �7I�V1/ DATE " RECEIVED DATE COMPLETED eV.