Loading...
HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: `1 _a l-li� 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: AIC_ Cl_ C4A PR�POSEDINROUEMENT LO ATI©'N: Address: %Qo ' tC"ryj oo d Q"�t QQ Legal Description: f G«' -ro1v� ����1 pw1a Property Tax ID#: s��" 3n -0o 101 —occ) —a Lot No. Site Plan Name: \ Block No. Project Name: i 1� �'G, \4 Setbacks Front Back: Right Side: Left Side: Rpm DETAILED DE�SCRLPTION t3F WORK: Add CONSTR�UN IN"FORMATION: Xwork to a performed under this permit—check a that appy: Mechanicall _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:$ 3 a0Cl Utilities: —Sewer _Septic Building Height: OWNER%1l1a8SEE: CONTRAC TOR: Name y ��� _ Name:,- Address: ame:Address: G FfltirG'UaCA C ► Company. City: State: Address: 11a6 r G H�Q Zip,Code:` k4 0(rL�p Fax: City: A— P a QA-,P-- Stater Phone No. Zip Code: . QP :. Fax: f9o1/`SI Y� E-Mail: Phone No Fill in fee simple Title Holder on next page(if different E-Mail j .t4 F o af9- @80 1. (U-t, from the Owner listed above) State or County License C14C_/F162S 0 r) If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. S 'PPCEM NT .I CO ST +U ION LIEN LAW I` FO'R' ATIORl 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 ins ion. If you intend to obtain financing, consult with lender or an attorney before commencing woyKV recording our Notice of Commencement. Signatur of ner/Lessee/ Signatu ontractor/License Holder STATE FLORIDA STATE OF FLORIDA COU Y OF t•1-�.r:a COUNTY OF '2-A c�Q_ Th orgoing instrument was acknowledged before me The forgoing instrument was acknowledgebefore me thisaZl day of 20 by this 2L day of 20 by �CtsSO,r� ��ra v�S3L. �Sa�n S}�a USS (Name of person acknowledging) (Name of person acknowledging) &a!�'yllxsc� (Signa ure of Notary Public- tate of Florida) (Signature of Notary Publi - tate of Florida) Personally Known OR Produced Identification �' Personally Known OR Produced Identification Type of Identification Type of Identification ProducedFL� -SAPZ_•y'2T- rlS-;. Produced - L LAsii„nNA INGRAM - .,,::aR=' Commission No. Seal:)- �- M L mmission No. sgrpiic-State of Florida �pShANNA iNGRA , . My Comm.Expires Dec 20,20111 y' State of flori a .N ,cc 6' tart'Public 20.2irFOFFI�PO�� Commission#FF 177249 1772 na o art' ss . REVIEWS FRONT =':z Ca ��tW6*1 ps ' NS VEGETATION SEATURTLECOUNTER SIV Bonde foREVIEW REVIEW . REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.