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HomeMy WebLinkAboutBuilding Permit Application .PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED Date: ] - �n2Al r-P Permit Number. CJ �✓ d I`I - Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FG 34981' Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential PERMIT APPLICATION FOR: Address: N w /P.14,e f=ern a-� Legal Description: Property Tax ID##: Lot No. Site Plan Name' Block No, Project Name: Setbacks Front Back: Right Side: Left Side: A001tiOnal work o be performed undertnis permit—crij!cK all thatappy: _Mechanical Gas Tank _Gas Piping T,Shutters ,,,,,,_Windows/Doors Electric Plumbing _Sprinklers Generator _Roof Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ � ��� -'� Utilities: Sewer _,Septic Building Height: Name J!EL/f � .n {l_er Name: CtxrtIs ,SO_VAMo on .s Address: —'24xI AJL,v &&J". Fes r C_4- Company: CjA, -rte Air 5!4 S e ins L-C, City: PA,JM state: fL Address: t 15 S& `fir 1± Zip Code:1 "9U Fax: City: P©Q T ST u c t e__ _ state:R. Phone No,7.7d 3,310 lll,j Zip Code: Fax: q7A 335 ?c E-Mail: Phone No. `77 36 �- Fill in fee simple Title Holder on next page(if different E-Mail: Cs�kC,01 e V^ from the Owner listed above) State or County License: CAC )RIO ` 54Ae if value of construction is 25Kor more,a RECORDED Notice of Commencement is required. ? 0 "OESIGNEENGINEER: _Not Applicable MOIRTGAGf 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 v ill 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 pians,the Florida Building Codes and 5t.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 recor"g vourrecur" Notice of Commencement. Signature of Owner/Agent/ see Signature of Contractor License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The fiar$aIng instruct was acknowledged before me this 1� day of_.,[ 1 ia.rT .20ILa by this q day of 20'1 by 19 t (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Public to of Florida) ( ignature of Notary Publi tate of Florida) Personally Known OR Produced identification Personally Known v'' OR Produced identification Type of Identification Produced 'Type of Identification Produced _ DWAL ES _ kv,-' kvmo g lti e . y5 75� 7e_.- IEIyC0A461IN011 fission No. -a a � 5 sI OZ S(8 Q 8:831 Id?G Commission No. ft'a', + � � Ell flex: r S.201'1 :dSLZZ A N015SIIWPY00 JIIY saedldlhNiNtdptIN wvv..REVIEWS FRONT ZONINUPERVISOR PIANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEWREVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.