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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED II r Date:�f"'3-Ili Permit Number: l l �© RECEIVED.. Building Permit Application FEB 0 3 2010 Planning and Development Services €'ERNUTTINGfit. Lucie County,Building and Code Regulation Division F L 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 IMPROVEMENT LOCATION: p Address: 0 WJ4,daAJQ0A Legal Description: Y.D'/ I ` F-- Z9 ig Property Tax ID#: 1 Z"1 e0 l t b l c7 6 Oar Lot No. Site Plan Name: Block No. Project Name: c�w�llll�� Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: 6,r s,2e, CONSTRUCTION INFORMATION: Additional work toe nertormed under this permit-check a appy: HVAC0 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:$ Utilities:0 Sewer OSeptic Building Height: OWNER/LESSEE: CONTRACTOR: Name VLOW-01- Name: ✓� Address: q 4-1 C7 "ClCompany: & W1 k--Ac c City: State: Cil Address: U_ i ✓ C- d( oe /� ' Zip Code: ( Fax:�QS_1T J-b-]`) City:_134I)Jt , 1f State: �, Phone No. Zip Code: �1jr1� D Fax: S10 E-Mail: Phone No. 49J1 3 �°o 05 Fill in fee simple Title Holder on next page rif different v` -Mail: from the Owner listed above) State or ounty License: 3T I If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION 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: 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 first ins tion. If you intend to In financing, consult with lender or an attorney before commencin recording our ce of Commencement. s _ Sig&aOwner/Lessee/Agent Signature of cor/License Holder STATE OF FLORI STATE OF FLORID // COUNTY OF COUNTY OF t_1 The forgoing instru �j was acknowledged before me The forgoing instrumt was acknowledged before me this day of 1D 20 �by this�day of F-��L!�I 20 by (Name of person acknowledging) (Name of person acknowledging) ALEXANDRIA CAMPBELL ALEXANDRIA CAMPBELL 9 16 R"Ptc =?a••••@'�cYWOAI FS, .; _ MY COMMISSION#EE 843913 MY COMMISSION#EE 843913 o r t ture of oto ubl off�I d'dYfirGs:OctoberI'c (Sig ature of N to Pu i ' oBd5lbt�tl® otaryPublicUnderwdters ry ;°f ,.` one Notary Public Underwriters ry N Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identifica on Produced Type of Identification Produced Commission No. (Seal) Commission No. (Seal) Revised 07/15/2014 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS