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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q' p Date: Permit Number: FS�21.11 M4— Y, Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginiq Avenue,Fort Pierce FL 34982 ' / Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential 6�-- PERMIT APPLICATION FOR: PR®`POSED IN!PRO�/EMENT L®CATI,ON: Address: OD 42-S Ct• / ` C (. Legal Description: S �-Ak&Wok f jU ,`F I ca- " 61-�it Etniexs" 0 6� 14W - 3,3-zil Property Tax lD#: ,g 7'- 6 r6 q ��©C� 9 Lot No. Site Plan Name: / Block No. Project Name: ,�,4��a10o� lC Setbacks Front Back: Right Side: Left Side: DEaTAIiLED DESCRIPTION ®: WORIK; 4 �� A Cb lU S Kit C �6 O S> � � C©NSTRUCTIQN INFORIUTATleiN: Additional work to be pertormed unclerthIS permit-check.all,that appy: _Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: ��(P / Sq.:-Ft.of First Floor: Cost of Construction:$ ®. Utilities: —Sewer _Septic, Building Height: ®�1N�NtER/LE=�S�SEE: CONTRACTOR: Name l .ofi Name: Address: 063 ; se6',-S ( Company: City, State:�, Address: Zip Code: V-1jz/9 .- if Fax: City: State: Phone No,&�z10 q-w4� 5- —Cc& L77l Ss(o 7 Zip Code: Fax: E-Mail: Ib V'A)6 Phone No Fill in fee simple Title Holder on next page (if different E-Mail from the Owner listed above) State or County License If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SIJPP'LEMENT �L C®NST'RIJCTION LIEN LAW INEF®RI�/IATI®N: WN 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 rgcKcling ydur Notice of Commencement. �Signature�o_f•Ower--/Lessee ent Signature of Contractor/License Holder -STATE OF FLORI Boz STATE OF FLORIDA COUNTY OF "�� COUNTY OF The forgoing instru nt as acknowledged befor n$eX�n The forgoing instrument was acknowledged before me thi day of 20 by " y _ y z�o� this da of 20 b v w 0_ (Name of person acknowledging) oA (Name of person acknowledging) �N I (Signature of Vary Public-State of Florida ) (Signature of Notary Public-State of Florida) Personally K-Rown OR Produced Identification Personally Known OR Produced Identification Type of Iden�6�ck, n n;, - Type of Identification Produced ,)GLC_ Produced Commission No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.