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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Ehq Permit Number: RECEIV7-D MAR 2 9x.016 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: .���� - �;a+ - xi i+.�`z PRC�PQSPD INPROUEi�ll�ElT LOCAIQN � s W051" 904ww" Address: t �� ` l 1 V+_ st LU 6t_' FL. 3L C Legal Description: Property Tax ID#: 3y �^ S Lot No. Site Plan Name: Block No.' Project Name: Setbacks Front Back: Right Side: Left Side: i,_o �32_ © ►n oi c-k1a rd, Additional workto be pertormed under tis 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:$ D Utilities: —Sewer —Septic Building Height: 01 MER/LESS£ RACT-n-­NI� 3 �e �." ., , _ CCT -- _ ,.x., . Name Ambel - R:\Ch Name: Address: �VC5 F_� Stp Ct, Company: City: Y'k- YC 1 l 1 1(� State: F-�_ Address: Zip Code: 34q?�3 Fax: City: State: Phone No.(3_1; ) -q'sq - Zip Code: Fax: E-Mail:QVM r k ch 13 (5�grna; l +"Ccn rn 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. 0N" 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 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.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,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. Signature of Owner/lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF 'Sk. COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this Q°N day of VvN 4 C ,20N by this day of ,20_ by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary ublic-State of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Id Personally Known OR Produced Identification Type of Ide ification pEFNN S�a�e ;0 6 Type of Identification Produced I L flIL �y p�b��X Mes ,PC1 ss roduced Commission No. (�°@mam• or4" N°lacy P Commission No. (Seal) _T REVIEWS FRONT : ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.