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HomeMy WebLinkAboutBuilding Permit Application All AP LP IC IELA NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: I Permit Number: leo� 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: PROPaSED INPR+OUEIUI�ENT LOCATION: ' Address:0g Loot,LA^n LEI 16- P/,-).(1L Q,(?'))C-Q, R, �5 Y `i1 5 t Legal Description: Property Tax ID#: Lot No. Site Plan Name: Block No. �5 Project Name: Setbacks Front Back: v,-' Right Side: Left Side: D°ETAI!I�E© DE-�S�CRiIPl"I®`N ®F W®R�K: t? /Doe ! H sal CONSTR(J:CTIQN IN'F®RMATION: WIN 11111 111! iorktobepertormed under this permit-check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of ConstructiopC Sq. Ft.of First Floor: Cost of Construction: $ 30 Utilities:; _Sewer _Septic Building Height: OWNER%LESSEE: Name FbA41k ULUai Name: TA �( Address: QQ Penov [ate Company: 3 City: Ry-f- State: tz_11 Address: Zip Code: Fax: City: State: Phone No. -56U I Zip Code: Fax: E-Mail: 4731JI S f421V 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. SUPPLEMENTAL C©NSTRUCTI©N LhEN LAW INF�RMATItJi1�: 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 work or recording our Notice of Commencement. �iazA Signature of Owner/Lessee/Agent Signature of Contractor/License Holder STATE OF FLORID STATE OF FLORIDA / COUNTY OF LSC. C' 42-- COUNTY OF The fprgoing instru t as acknowledged before me The forgoing instrument was acknowledged before me this ay of 20 by this day of 20_ by (Name of person acknowle ing) (Name of person acknowledging) 442 (Signature of Notry Public-State of Florida o.(Signature of Notary.Public-State of Florida) Personally Known OR Produced Identification Personally Known OR ProducedIdentification Type of Type of Identification PrOdUC Produced,•``Parr . Notary Pubite-State of Floridj) \ Commi mmission-z Co4E FF 234 Ra Commission No. (Seal) "Ir i��P•`• Y omm.Expires May 27,2019 Bonded throw h Natio REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER" 'REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 7/2014