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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 2' 2' RR Permit Number: d 05 FEE Ime 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 V\ PERMIT APPLICATION FOR: PR: POSED IN ROEIV) TK4 �QN ti VEN "�.,,x<a -�.,r�:,.. �-.�� .a&�'`�.��.r...,a,e,�-a.. Address: 55 o -7Syn Sei-_ G1 VC! r4, 17(er C ��-• �� �_2 Legal Description:. Property Tax ID#: -SL loA.I.CU9 • x-)-49. DX1_'09 Lot No. Site Plan Name: Block No.' Project Name: Q��VQC�� Y1C2 Setbacks Front Back: Right Side: Left Side: �° e rte, �.>§-' ,�. xA� t s d rSw a r i. rv. b DETA( ED DGR�PT((3NCF 1NORC� �� 1p_.. 3�.w0'.3tr: 'eAdditional work5to be pertormed under tis permit-c ec all that apply: _Mechanical _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: —Sewer —Septic Building Height: 4� .�:..; `�"' aUN�R/L�S5E� � r /� r{r�IYT[��L�C�f1. r..s.,s,�iz Name►Cht I k, L. k Name: Address: 5 S 0-1 SU*f1 Se+ Company: City: I-- 0(e_rCt State: Address: Zip Code: Z Fax: City: State: Phone No. -1.2 7& 89 Zip Code: Fax: E-Mail: M,CktAle)J !Q q© omni l . C 0M 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. DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable 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 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.l 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,screenrooms 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 property. A Notice of Commencement must be recorded and posted on the jobsite improvements to your'� before the first inspect n. If you intend to obtain financing, consult with lender or an attorney before commencing work or r rcling your Notice of Commencement. "A ignature of Owner/Lesse ontractor as Agent:!:r Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF 54 TY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me thiL day of �t @� ,20� by this day of ,20_ by (Name of person acknowledging) (Name of person acknowledging) S' natu a of Notary Public-S of Florida) (Signature of Notary Public-State of Florida) Personally Known Dc-e&IdentifivatiGn-_j �, rsonally Known OR Produced Identification ,�.•"'� �,Q LASHAHNA INGRAM Tye of Identification Type of Identification a,, P Produce 60Q0RD State of Florida Produced = *•; y Comm.Expires Dec 20,20 8 E ��;� rSC� fission#FF 177249Jo mmission No. (Seal) Commission No. ' F°FF�°`� do „` B de rough National Notary As REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.7/2014