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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: y 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: PROPOSED hNP OUEMENT LOCATI.O . Address: 26116 12aLs9A A-T, Legal Description: St-�inw(�L I AYLiL PropertyTax ID#: 401 MK7 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DR+IPTI®N Of 1N�OR�K;� CQNSTRUCTION !NIF©RMATION: Adafflonal work to be performed under tis permit—check all that apply: _Mechanical _Gas Tank _Gas Piping _Shutters _Wihdows/Doors; Electric _Plumbing _Sprinklers _Generator Roof Total Sq. Ft of Construction: 9409 Sq. Ft..of First Floor: Cost of Construction:$ 2cly a&0 Utilities: _Sewer _Septic Building Height: S OUVI LEESSE4E: C(JNI"RACTQR: NameIpr;sL•i PabpN6 Name:_ Address: SS3d LRUSS lit -0"V A Company: LA.f, City: '}ii Qflr Stater Address: '3L'( �iL�,p%y�—1r� Zip Code: l Z Fax: City: fj� ffaq;�e State:(,, Phone No. Zip Code: .3 q'Lgj Fax:`J)Z"4(41 bG�� E-Mail: 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. . SUPPLEME T L CONSTRUCTION LIEN LAW INFORMATI'4N: 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 t our erty. A Notice of Commencement must be recorde posted on the jobsite before the fir ink tionrX, you intend to obtain financing, consult with I er orAn attorney before commenci E wor or recor in our Notice of Commencement. Signature of Own ee/Contractor as Agent for Owner Sign re cens STATE OF FLORIDA STATE OF FLORIDA COUNTY OF S: 1•. 1 COUNTY OF Sir „ The forgoing instr ment was acknowledged before me The forgoing instru nt was acknowledged before me this�day of 20� by this� day of 2t 20J by Qk (Name of person acknowled g) (Name of person acknowledging) &sw— QdKt�&' (Signature of Notary Public-State I Florida) (Signature of Notary Public- tate of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced ... VL%-l' C'r23S `19S-1o. .ptio3•p �" .;i,S Commission No. Not P lic �tatu of Florida Commission No. b � }'° --..4 4. _ *._My xpires Dec 20,2018 LASHAHNA INGRA . Apar n�• ��* =N.* oma; Commission#FF 177249 Notar Pu %'� `o¢•� Assn N* *mss MYGomm.Expires Dec 2 Florida REVIEWS FRONT c wpl EA\ l$pf� '42� NS VEGETATIO SEATURTLE MANGROVE COUNTER;' Bond dthrNkAE'WalNota EW REVIEW REVIEW REVIEW y DATE RECEIVED DATE COMPLETED Rev. I