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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE NFO UST BE-COMPLETED FOR APPLICATION TO BE ACCEPTED67C) `�� Date: Permit Number: 'I ' 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: VO r'416') c'SL_)w+'er /ew4-ef- ai4. PR®'POSED IN!PRO�/EM!ENTt' L®CATION: Address: J Legal Description: Property Tax ID#: A/ 3;Z- �0 6 - U 16 6 — 000 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAIiLE® DESCRIPTION' 911 11UORK: &WWWR q0 110') r,as t"4vf+ �C®NSTRfiIJ.CTI®N IN?F�OR+M�AT'I=O�Nr � � � Additional work to be pertormed under tis permit-check all that appy: Mechanical _Gas Tank _Gas Piping —Shutters _Windows%D'oors Electric /Plumbing _Sprinklers _Generator _Roof Total Sq.Ft of Con'structio,n: Sq. Ft.of First,Floor: Cost of Construction:$ /000. 00 Utilities: Sewer Septic Building Height: _ ®INNER/LSE=�S�SEE ���� _ CONTRALTO Name /"t'(S• SCS ` Name: �^� t S �a]1i►�Glrl Address: Company: C,l :.5�diroe�r James"ri'� City: State: Address: /76 )° S� 3 7 0 Zip Code: Fax: City:0 r j34l State: Phone No.17-'72) WC- -7036 Zip Code://9110)t-'1-7 Fax: E-Mail: Phone NoC.L ,) TO ?- 367 Fill in fee simple Title Holder on next page (if different E-Mail from the Owner listed above) State or County License o..g 016 6 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. i StJPPLEMENi" 1L C®'NSTRl1`Cl'I©N L IEN LAUD 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 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 k or recording our Notice of4ornmencement. Signature of Owner/Agent/Lessee/Con r Signature of Contractor/Licen er STATE OF FLORIDA / STATE OF FLORIDA COUNTY OF �,C��'�� COUNTY OF The for oing instr t was acknowledg d efore me The fprTing instrum t was acknowledged before me this�day of �� 20 y this day of 20L by (Name of person acknowledging) (Name of person acknowled ' gCI ) r (Signature of Not ry Public-S ate of Florida) (Signa ure of Nota P b it-State of Florida ) Perso II ,f6 ication Personal) Known OR Produced Identificati n Y X•�'kJ,; Type of Id sJ Type r • i orNotary Public-State of Florida Produced ANGELA M HUFF Prod u ••= Com """"'•. 4i<30 =.� Notary u l - t Florida .F P�°•�' My Comm.Expires May 27,2019 :¢,° °;; ``� ••? Commission#FF 219730�9 Com Bonded ttaough National Notary A Co m m i ss i o Rr Expires May OF i�P�`� '�,,,,,,�° Bonded through National Notary Assn.• REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Te-Tv.