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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 19C6 � 1 Date: Permit Number: I 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: PRGP©SED INP�R.ou,EME 'to ATIQ / / Address: Legal Description: Property Tax ID#: 15101 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION C}F WORK: s IVJ PJ IQ C®NSTR+l1CTI0N IN,FO.RMATION: Additional work to be performed under this permit-check all that appy: —Mechanical —Gas Tank —Gas Piping —Shutters _� oof "(/Windows/doors Electric PlumbingSprinklers Generator I/R0170-,L 5-47 Total Sq. Ft of Construction: < Sq. Ft. of First Floor: Cost of1Construction:$ �� Utilities: —Sewer —Septic Building Height: OUVNER/LE=�S�SEE. ,x a �_C®Nl"RACT®R: .�. a e' Name: r' Address: ' Company: 6, J* City:�`/� imC�i State:k- Addre Cl r Ewer 4 Zip Code:3�lQs�/ Fax: City. if State: A, Phone No.77R - 4460 -62,77 77 Zip Code: 14 Fax: p E-Mail: Phone Noe7 7 Fill in fee simple Title Holder on next page(if different E-Mail from the Owner listed above) State or County License t� d If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SlJ'PPLEMENTAL C©NSTRUCTION LIEN LAW IN'FORMATIO:N: DESIGNER/ENGINEER: _ Not Applic MORTGAGE COMPANY: _Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: P one 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'permft`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 orand 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 Commenceme be recorded and posted on the jobsite before the first ins ion. If you intend to obtain financ' g, con It a der or an attorney before com ork n ur Notice of Commence en . J Si ature of Owne /Les e/A ent gnature 'Con ractor/ icense older } STATE OF FLO IDA r STATE OF : O DA COUNTY OF —� COUNTY OF The t going instru en was acknowledged before me The f r oing.instru was acknowledge fore me this day of 20 y this day of 20y (Name of person ackno edging) (Name of person acknowledge g) (Signature of Not r Public-State of Florida ) c-State,of Florida) a nown OR Produced Identification /-KneProduced Identification en k ir- ell I e o Producer ,,��Pa�P,el, ANGELA M HUFF _ 4P 4�1,y GE! wdly 4- �p- Commis is State of Florida , . to -gtto; aCom�nissio' :�M ,, �_ Sion#FF22� a1) Cotirrhi ic¢g sslon olf/or (Seal;) s May 2019 XPire 73p through National Notar °� y Assn: rhr gh Nalio„May 27,2p l g P­11YA SR REVIEWS FRONT ZONING,. ,SUPERVISOR PLANS VEGETATION "SEA-TURTLE MANGROVE COUNTER REVIEW.` :'. . 'REVIEW REVIEW REVIEW REVIEW ' REVIEW DATE RECEIVED DATE COMPLETED ev. 712-014