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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 11I "" Date: Permit Number:.- 160(D— (1 x(0 S' IV itE� �. r.� JUN"D 2 201Q Building Permit Application Planning and Development Services fig,umte Comw,F;L Building and Code Regulation Division i 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: PR®`POSED INPROVEMENT L0 ATI10 : Address: X30 `Z, '0 e �1 W�� � - d"G� f'j , �q�.�1 Legal Description: 1-. X IZ. 540rau A kif Property Tax ID#: CW (� ©MIC) Lot No. i Site Plan Name: Block No. I II. Project Name: �c Setbacks Front Back: Right Side: Left Side: 'll DET NME4=RIPTION OF WOR? l 11. �.� c o -FI�e `�kn L; 5 CONSTRUCTIONI FO'=VTEN: Additional work to be performed 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: Li L( Sq. Ft.of First Floor: Cost of Construction: $ - aMWUtilities: _Sewer _Septic i Building Height: fI OWNER L&Sfi' 1CO N 01RACTOR. Name (,o;11X w< AAiv; Name: Address: 002_ betwoJ Ale Company: r City: F-4, P Cyc t State: Address: ;II Zip Code: 3t c1S I Fax: N/,4 City: State: Phone No. I-1-U) 33a - (vcldr0 (f Zip Code: I, Fax: E-Mail: U t'��vuA �C�ISDtnt�,N�� Phone No Fill in fee simple Title Holder on next page(if different E-Mail from the Owner listed above) State or County License I If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. i i SUPPLEMENTAL CONSTR'UCTI®N LIEN LAW INiFOR+MATiON: DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: I.—Not Applicable Name: 177yi5 &G110 Name: Address: A60 Sk, UGD Address: City: State: /=t. City: State: Zip: 3 7 Phone _ 3�L a3 53 Zip: Phone: FEE SIMPLE TITLE HOLDER: mot Applicable BONDING COMPANY: t,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. j St. Lucie County makes no representation that is granting a permit will authorize thepermit 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 a'nd 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. i to .,. 1p, &1- Si nature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/Licen'se Holder i STATE OF FLORIDA STATE OF FLORIDA COUNTY OFCOUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this 11-day o6m,iwQ-' 20 fo by this day of 20_ by (Name of person acknowledging) (Name of person acknowledging) i i (Signature of Notar ublic-State of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Idem= lly Known OR Produced Identification Type of Identification �'` ,, ,,,' LASHAHNA lid- Jepsoofa e Identification Produced ;�� ``e�%- Notary Public-State of Flori aIoduced �— fres Dec 2o.2 tSa0• L%. _. e My Comm.Exp'Commission No "ss+ 'o`; �1msion#.FF 177249 (Seal) P, A mmission No. Q •,, ,,,�•, �Snd�thrnuoh National Notary j REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED i DATE COMPLETED Rev. 7/2014 i