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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICMLE NFO LIST BE FOR APPLICATION TO BE ACCEPTED Date: Permit Number: 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 here PROPOSED INPROVEMI NT LOCATION Address: 920, 'F -�4Vvoeb _ Few+ �tv,ce i F6 '34P"92- Legal Description: av-( L-c+ IW Property Tax ID#: •304— SDG ®c��y ©'D0�tI Lot No. ry Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED ©ESCRIPTION"t3F WOR�C I�- I wic Mr A, �cs�s y- � ��r s w'4k k n<-,,c4- CONSTRUCTION 1:N'F OR''M­ Additional work toe e orme under t is permit c ec a appy: HVAC Ej Gas Tank ❑Gas Piping _Shutters Windows/Doors 11 Electric ElPlumbingSprinklers E Generator 1:1 Roof Total Sq. Ft of Construction: � S Ft. of First Floor: j Cost of Construction:$ `1 Utilities:cn Sewer 0 Septic Building Height: U1lN,ER/LESSEE: CONTRACTORFfl Name 70+.nil,e... 5� � Name: LV44 V, Y� r►� Address: (243 •1- w*J (.r. Company: gur' , 4'aw-e- "} City: &f Q State: Address:: No 70 11v •3e I vet_ Zip Code: "31M VZ Fax: City: ge/1u'..J State: �L Phone No. Zip Code: "i3'3 i Z Fax: E-Mail: Phone No. qCJ`�-��Z- F�-f►5 � Z 3 Fill in fee simple Title Holder on next page(if different E-Mail:�l EsQ.o��`C� �K�AQ�b�0�C�'�S •CDW from the Owner listed above) State or County License:CCC,nal If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. S.UPPL'EMENTAL CONS 'RUCTION LILtV LAW INF.QRMATI(?N; pp MORTGAGE COMPANY: _,eNot Applicable DESIGNER/ENGINEER: NER/ENGINEER: Not Applicable able 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 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. Signatu Ff caner/Ag t/a a ontra r Holder or STATE OF FLORIDA Ld`G STATE OF FLORIDA COUNTY OF i' COUNTY OF ,:;Sd-. I UGH The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this I day of 7 20©by this day of 20®by (Name of person acknowledgi ) (Name of person acknowledging) • (Signature o Notary Public-State of Florida) (Signature of Not u lic-S of F ri a) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Produced Type of Identification Produced Commission No. — Commission No. (Seal) lPRY PLB"• _� A MATTHEW BIRKINS '.. .... r r of EXPIRES July 2.2017 a Notary Public-State of FMe Revised 07/1 %20.3.4..• '` Commission A►FF 20fes jun 2315 (407)398-0153 Florid allotaryservice.com REVIEWS FRONT ZONING SUPERVISOR PLANS 8a Assn. OVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED