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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ``II c l Date: Permit Number:J( • 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: To Select from dropbox, click arrow at the end of line PROPOSED IIM�P'ROVEMENT,LOCATIO.N Address: p ZZ1671165PLA) Legal Description: Property Tax ID#: 115W— 5V L 676 7— Q60 S Lot No. Site Plan Name: M Block No. Project Name: Yy� � Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK - 1.,CONStRUCTiON,"INPOR.MAT-ION: Additional work to be nertormed under this permit—check a appy: HVAC Gas Tank Gas Piping _Shutters Windows Doors ❑ a 2lectric 0 Plumbing Sprinklers E]Generator Roof Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ � Utilities:0Sewer OSeptic Building Height: bWN ER/LESSEE CONTRA:C.OR: Name P,IGJ•l p lid Name:rAyA:- e&l9AA1M_ Address: Company: lTCct1R/i"1-E i✓LEC'T ift) 6%1" city: B 64CH State:EL Address: 734 UI07F/ & Zip Code: i• 1—<7 Fax: city: PORT Sr L-06le State Phone No: X702_oT r C'?-3S ZipCode: 3 4 VoI Fax: 77oP95y E-Mail: Phone No. 77c2— 370 -5- Fill in fee simple Title Holder on next page(if different E-Mail: tj G1lKftN*V(9 4-0'1 V6 7— from the Owner listed above) State or County License: 6G 0003 C7ol If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. , UPPLEMENTAL`C.ONSTRUCTION LEEN LAW INFORNiATIC+N DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone: Zip: Phone: FEE SIMPLE TITLE HOLDER: u Not Applicable BONDING COMPANY: _Not Applicable Name: Name: Address: Address: City: City: Zip: Phone: Zip: Phone: 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 thepermit 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 irst inspection. if you intend to obtain-financing,consy#with lender or an attorney before comme I work or cording our Notice of Commencement Sign a of Ow r/Agent/Lessee Signa ure ofrimt or License Holder STATE OF F RIDA STATE OF ORIDA COUNTY OF COUNTY OF The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of �,� yt 20 by this day of ((�,r} 26-4by Em (Name of person acknowledging Na a of person acknowledgt (S' nat a of Notary Public-State of Florida} Sig ature of Nota Public-S �' to of Florida} Personally Known OR Produced Identification` Personally Known Type o Identification Produced --OR_ Produced Identification ~" a Type of identification Produ;ed Commission No. TS (Seal) Commission No. Revised 07/15/2014 LASHAHNA I"NGRAM �,` My Com !n_ Notary Public-State of Florida �ammfedrpn REVIEWS FRONT ,�n 11�9Q'llffpV 1l'ggg Qg� , 7249 �N�1/of�N�/gtrlr COUNTER RE V Bo d �tV�t I C tary�� V Vae�� COTE .. E"vl R€ REr,4tl©N COMPLETE 4r�i LCA INITIALS ` V/Ew f X46 r riView