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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO ��MUST.BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: (.�' ' o"��. /�l Permit Number: Frm- s r - Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 /1 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential !/ PERMIT APPLICATION FOR: T PRQPOSED IIVPROVEMENT LCCATIQN xF Address: I 1 G eou T4 kCce T 3 0 Legal Description:�r6m Q b(MIA q�g.�,� b e l©' 5 p� 46 �_F�� p '{�e I�l,� fly p��{�e tV �oWXA,\!P Sa�cA2 0,7c- SA-` C,\,e (G\JAky Property Tax ID#: Own —3 /2 — 00 0 0 Q Q Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION IPrVORK VA- Te �$G,( S' �1 2 CONSTRUCTION IN�ORMATlON , �� � ,: � � ° Additional wor to be pertormed under this permit-check-aTFtfiatjapp y: _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: $ '�of� Utilities: —Sewer _Septic Building Height: 01NI�ER/LESSEE a"CONTRACTOR��� : '� ' v y� 3 E Name 0-00 Na"rie- Address: $1``(0 •�P � cf�11 Company,:. . ' y `gyp � �' City: �'. L�y 1 U Ti •Stater Ad Zip :!tii:':1'it'.1;,L!iu' Zip Code: 330 R Fax: City: r v � State: Phone No. Ct 5Y 910 22- Zip Code: Fax: E-Mail: u v e �C�� Phone No Fill in fee simple Title Holder on next page(if different E-Mail from the Owner listed above) State or C unty License if value of construction is 2500 or more,a RECORDED Notice of Commen ment is required. SUPPLEMENTALCONSTRUCTION LIEN LAW INF.;ORMATION 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 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 nod- sidential 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 Contractor/License Holder STATE OF FLORIDAC., STATE OF FLORIDA COUNTY OF COUNTY COUNTY OF Thefor oing instrument Was acknowled a fore me The forgoing instrument was acknowledged before me thisay of 20by this day of ,20_ by L�, ,ov, ouk 2c1il�o (Name of person acknowledging) M (Name of person acknowledging) h/A (k,mfure of N I ry Public-State of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification VZ Personally Known OR Produced Identification Type of Identifi t' Type of Identification Produced ANGELA N1 HUFF Produced -s Notary Public•State of Florida Commission No. •i Commis FF 234730 Commission No. (Seal) y Comm. xpire May 27,2010 � N°; ��•• Borbed ttrouph National Notary Asan. REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.7/2014