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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE Permit umber:N � A0 Date: 4�i J r- i • � 1 v)a _ -- Building Permit Application m1 Ll l'n ,n1 Planning and Development Services Building and Code Regulation Division L - 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: PR,�P�SED INS� ROVEMENT LOCATION: Address: R l 5-0 (V 4 ( A 1 i7 a ` C Legal Description:_- 'T-11 Ta INe�S Ur,, ` U �" Pi- `(/� �Pr uy( A- Property Tax ID#: A iO0Q 000 Lot No. Site Plan Name: Block No. Project Name: V W er's, Setbacks Front Back: Right Side: Left Side: DETA[`LED DE�SCR+IPTION OF VI/OR+K: CONSTRUCTION IN1=©R :ATION: Additional work to be pe rmed un er t is permit-c ec all that appy: . _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors Electric v/Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction:$ Utilities: _Sewer _Septic Building Height: 0 NER/LEaS�SEE: CONTRfACTOR: Name, S 'Name Addie"ss: 1. �& Company: '' l,L City rj State: ) Address: S S: • t'� w �1 Zip Code: Fax: City: j- I -e��C State: �— Phone No. �� o�^ �l� � �jy Zip Coder Y 9 Fax: E-Mail: Phone No `7 -7 — R, Fill in fee simple Title Holder on next page(if different E-Mail -e-eI,) t— from the Owner listed above) State or County Licensee )Y.� / ?/Y_ If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. Sl1PFid N SAL CQNSTR�IL@Nfl LA1N IN �ORMATID`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: _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 wi h lender or ttorney before commencin rk or recgoing your Notice of Commencement. Sign re ofOw e0 Lessee/Contractor as Agent for Owner ignatpee of Contr ctorycense Holder STATE OF FLORIDA // C/- e, STATE OF FL RIDA COUNTY OFS/_ , 6,G COUNTY OF �, T�/ —- �_ye /,.e The forgoing instrument was acknowledged before me The forgoing instrument wa acknowledged before me this day of j7Lw/-c,420 hf by this�day of A4'G 20//by r (Name of person cknowledging) (Name of person cknowledging) (Signature of NotaryPubl'c-Stag of Florida ) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification 'Personally Known V PuOR Produced Identification Type of Identification Type of Identification Produced _°��""e'••. ANUEL GAGE Produced ,.• MANUEL GAGE °•' MY COMMISSION#FF027723 \ M Commission No. =- ;a� Lc�I Commission-No. All� ?�, C SION#FF027723 EXPIkolne 16,2017 ;o. Y E PIREJune16,2017 (407)398-0153 FloridallotaryService.com M1 407)398.0153 FloridallotaryService.com REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.7/2014