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HomeMy WebLinkAboutBuilding Permit Application `'All APPLICABLE INFO MUST BE,.COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: Vlt J� or 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 �c PERMIT APPLICATION FOR: Address: ' tA1DiftJ RJVU, DP, Legal Description: Property Tax ID#: �s� — (Xa© B®© Lot No. Site Plan Name: p Block No. v Project Name: M 7 EKS Setbacks .Front Back: Right Side: Left Side: 13 C'HIW6E SEF WiCE 60,0M NWAD Td 000 aMPyMWO0,001Z III i 101115M 45 1; 1 01 ,1�11i�11111' ill Acid itiona I worK to be pertormed under this permit-checK all that appy: _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: Name Pffimel-Ht M Name: A kriiquk �A)�ELr�ANnI Address: Io2yoZ! -��nWbIA-t1 RIV61k -R Company: AlncukA' -TE F�LEc-r21CP l0><1�ftC'TiAI6/ City: S_EJU5fnl P,6ftCN State: Address: 7—'W &AoTti PL Zip Code: 3q95-7 Fax: .City: W7 Ss Lo State: riL Phone No. Zip Code: 31.75 Fax: 7702- 87,E-X51 E-Mail: SCO IT C@.AS_r4A-A/D3(fR-PIIJ(;,COM Phone No. 77a- i5�- 91 -71 Fill in fee simple Title Holder on next page(if different E-Mail: pQV;e1 nlCE{@ 471-, A).61- from the Owner listed above)- State or County License: ECWC3072, If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. 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 t4 first inspection. If you intend to obtain financing, consult with lender or an attorney before commer,fting workgr recording our Notice of Commencement. Signa a ofOwf r/Agent/Lessee Signature of Contractor/License Holder STATE OF FLORIDA �l l STATE OF FLORIDA COUNTY OF . " `�''4�Aa� COUNTY OF The for'oing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of20_U by this day.of 20_.by (Name of person acknowledgin ) (Name of person acknowledging) Oigdature of Notary Public-State of Florida) �' ' (Signature of Notary Public-State of Florida.) Personally Known OR Produced Identification Personally Known OR Produced Identification T e Identification Produced` Type of Identification Produced Commission No. (Seal) Commission No. (Seal) F.P. to oa LASHAHN IAhall REVIEWS _ FRONT ZO I �* t UAIaPy I �R tVEGETATION SEA TURTLE MANGROVE . COUNTER RE € REMffiWExpir s REVIEW REVIEW REVIEW . DATEF,�� mmission FF 177249 ... Bonded throu RECEIVED gh Nat nal Notary Assn. 4,, DATE .� `>'." COMPLETED ev. 7/2014