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Home My WebLink AboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: `� X01�S Permit Number: ""` RECEI1,'--p NOY 10 2013 0. 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: PROP©SED INPROUEMENT LOCATIQN: Address: Ud 14cr oa— �r(,_ ✓fw Legal Description: Property Tax ID#: LVA a1S Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: �L@@ DES` ami� UFWOR' 7o VC) to 0 +Mp 0 �11N FORMATION: Additional work to be pertormeU un er this permit-check all that appy: _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:$ ) Cd 00 = 0 Utilities: —Sewer —Septic Building Height: OWNER/LE�S�SEE> C4NTRA�TO`R: Name 01- 0 in Name: Address: l7 600 1",eC& ►S Company: �►�Kw••�Z �s�� City: Alm .64State: FC_ Address: _�S6 Zip Code: 3,Iy`'® Fax: 'M - City: rf ;/yAt State: C Phone No. FIs - 3,006 Zip Code: 3,{5 Ll'7 Fax: Y4 E-Mail: Phone No Fill in fee simple Title Holder on next page(if different E-Mail i`�Q✓�.J�?i•�ca 1121, C�,�,� from the Owner listed above) State or County License C:C 13do S'S 177 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. 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. �C_ 4_4_� C� Signature of Owner Lessee/Agent Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF '. L zr_"% COUNTY OF The forgoing instr ment was acknowledged before me The forgoing instrument was acknowledged before me this day of N44 20 by this A Lclayof 20-\; by �0Of v\-R,aJ (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary P ic-State of Florida ) (Signature of Notary ublic-State of Florida ) Personally Known OR Produc h%�M Personally Known OR Produced Ident' tin Type of Identification �„ otary`�o�Po.E�.Q`�#EE Notary PSS° Identification aSS�S1 ProducedProduced D) pN \te°tF\0�20�6� 1. ,,,, ,,,,, NotatY Q° \`Xpices�e 858761 Commission No. P� �om��s��{�°°a\ Comm ission No. \�yGomm.�� ,�aN}Ea\NotacYPssn. b 3. °odea mss° �: �: edZhtou9 REVIEWS F N ZONINGSUPERVISOR PLANS VEGETATI SEA TURTLE., MANGROVE CO "LATER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.