Loading...
HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: l /� C7II wwrr i yEe«IUB! 9wsypew w RECEIVE, �II BudQCTding Permit Application 0 2015 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 7C PERMIT APPLICATION FOR: PROP05ED !NP' C} EME T OCATI + ; Address: 2- /,L/ %� tr"cfcc r`y t 74- Legal Description: Al C_. _ Property Tax ID#: Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side:" Left Side: DET ILEI DESS RIPTI�• 4F WORK: __ - CONSTRUCTION INFORM TION: Additional work to be perfibrmed under this permit—check all that app y: XMechanicai ;Gas Tank Gas Piping ^Shutters _Windows/Doors T Electric —Plumbing ' _Sprinklers `Generator Roof Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction:$ 0O 100 _ Utilities: _Sewer Septic Building Height: i _;;• `1:ctdusart:.�amr&r,ek��A..sAC+u,:t+;e4:�u�dPSc-�++a'° r, `'CtiatY►e' itG ' �-1��. NG 1 c Name Address: corn 6hy:s t,-C lit City: ' L v t ; State: t''r, Address: /�!, S� Zip Coder _ ' 3—�1—� Fax: City: State:,*�"—_�- Phone Na.�� �� �$� d � �r� 2z 3—y�`�pZip Code: Fax: E-Mail: Phone No—77-2 7-Z ! '2 Fill in fee simple Title Holder on next page(if different E-Mail from the Owner listed above) State or County License • fPf 8 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL C©NSTRtUCTION LIEN LAW IN°�OR�MATION: 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 recording our Notice of Commencement. Signature of Owner Lessee/Agent Signature of Con or`License 461der STATE OF,FLORIDA STATE OF FLORIDA COUNTY OF CO-LINTY OF The forgoing instrument was qcknowledged before me The forgoing instrument a acknowledged_before me this,day of G� �:� 20 JLSby this 2D day of A ,20/. by (Name of person acknowledging) (Name of person acknowledging) (Signature of Not blic-State of Florida) (Signature of No Public-State of Florida) Personally Known Esme ).duced1Id fpglggmt�n Personally Known Type of Identification =� ��i Notary.Publlc-State of Florida Type of Identification s.``��*' 4•a Produced + Commission#FF 184850 Produced .� fi': Notary Public-State of Florida 's,+� p��.• My Comm.Expires Dec 22,2018 oma; ommisslan#FF 184850 Ronde '��iFOfF�� My Comm.Expires Dec 22,201 11 Commission No. �nd National Notary Assn. Commission No. ���, � Bon eah),ghNationalNotaryAss . REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 7/2014