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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUS BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: ' 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: Trip,NPROVEMENT�LOCTION. �� �, c t.'HSxxs seaw„a .mcx,++.a„r*.-rt u,.a i,'bn�x �a... c� rt m'aw.W �km..c Address: S Legal Description: C pa C_ Property Tax ID#: (c) Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION'DF WORK:' CONST�RtJC�l' O,N 1NiF0RM: el�®N: . A rtiona wor to a per orme un er t is permit—c ec a t at app y: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors' _Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: Sq. Ft. of First Floor: i Cost of Construction: $ Utilities: —Sewer —Septic Building Height: Name Name: ti Address: is�©�� �,l�-�n ,S. �—. Company: �` 5 r1 i City: T:n4 P?�CP►- State: Address: me— NM._N' Zip Code:_2SPtt!" Fax: City: )P—A Stater Phone No.C-_?'?a, S 1,:!� ^;L(o (RU Zip Code: LEL Fax: E-Mail: Phone 4-72-)N IV T I T2 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. 11PPLENIENTAL C®NSTRtl1'CTI®N I:IEMN IL,�W INFAD,RtM/JTION: 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'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 theJobsite before the first inspection. If you intend to obtain financing, consult with lender or an attorney before comme work or rpcording your Notice of Commencem S gnature of Ow W r/Lessee/Contractofas Agent for Owner Signature of Co tractor/License older STATE OF FLORID STATE OF FLORIDA COUNTY OFA COUNTY OF � The f ing ins1t;uruent was acknowledged before me The f ing ins nt was acknowledg e_fore me this day of 20�by this day oC1 20Wo by D�it•� oama:�:�l I Ga_v�, d F�.,. ,,s (Name of person acknowledging) Ij (Name of person acknowledging) nN\,9�4, _0� 6- �� LI: D-A-\-Q� M(& I,_6 (Signature of tory Public-St9te of Florida) (Signature of Not Public-State of Florida) Personally Known Y .Qroduc4WA Y ,�������� ""' > �YF � Persona '' • 'r �� UFF ation Type of Identificatio R *�= otar Public-State o I N tar Produced : w- mission#FF 234730 Type o „ i l ».- Com u h "State of Florida 1 Expires May 27,2019, Produc ";' R,. 0 �•,FOF F���` Bonded through National Notary Assn ; •,,o Ffo,� Y omm,Expires May Bondedthrou Y27, Commission No. (Seat) Commiss: 9h NationalNotaryq REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE- MANGROVE COUNTER REVIEW ` `REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 7/2014