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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: 1,S) t'ca I 77, 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: � Q� PRQPOS.ED OV ,ENLOCATION Address: 76 Q-� Legal Description: ��� � �"� ��4� '��` �l �� s-g &A 6 Property Tax ID#: (n©e-) 7 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK '"a A .,,.p 0-V 0�n w 0.4<-, < v\1 L . CONSTRUCTION 1NFORMATION .t.. Additional work to be performed under 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: $ b S Utilities: —Sewer Septic Building Height: OWNER/LESSEEh a . //��,,,, CONTRACTOR Name l�C© ('0.trD Name: �'� I11,/ -G Address: pany: City: RS C State:-CL. Address: -7`Z- SL,,) C.J1' iki /c, t- Zip Code: 9V5 �(o Fax: City: �_ State: L Phone No. 77 2 3?r'�/r,S y Zip Code: q91 Fax: E-Mail: �' Phone No `-7 7 L 3 7 0 // "- Fill in fee simple Title Holder on next page(if different E-Mail 4' vyd z)-� V h"�t'h QO[Ca 1-, from the Owner listed above) State or County License if value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SU'PPLEIVIENTALOONS RUCTfON LIEN LAW INFORMATION 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 struct?"rk imming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use WARNING TOER:Your failure to Record a Notice of Commencemen/re res in your paying twice for improvemeno property. A Notice of Commencement must bede and posted on the jobsite before the fi p tion. If you intend to obtain financing, consult wr or an attorney before commenci r r cordin our Notice of Commencement. 14 Al/01 Signatur Owner/Lessee/Agent Signatu e f tractor/License Holder STAT F FLORIDA STA OF FLORIDA COUNTY OF .1,,,> COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this ID,_day of 1"bv 201,S by this day of ,20_ by !1 � f� Oe'rrnA � �� �A (Name of person acknowledging) (Name of person acknowledging) &�;� 6o�- \'� (Signature of Notary Public State of Florida) (Signature of Notary Pubk-State of Florida) Personally Known OR Produced Identification V Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced �� SHAHNA INGRAMIs " mmission No. ..... �19 AHNA INGRAM Commission No. aY�� -, ((Sed ublic-State of Florid Notary Public-State of Florida •_My Comm.Expires Dec 20,2018 = ; ;• M COMM.Ex ' orn i 's, ; .;� Commission d�FF 177249 A! FREVIEWS FRONT ZCjNING SUPERVISOR- LANS VEGETATICI SEA TURTLES nrescMANGR�I��tssn i COUNT `REVIEW REVIEW REVIEW REVIEW ' REVIEVII'"" ' REME-W� '- DATE RECEIVED DATE COMPLETED ev. 112014