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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFOMAST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 7- I — Permit Number:.\�° ' (3Q) RECER'-D JUL 01 7.036 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: To Select from dropbox, click arrow at the end of line M o c_ PROPOSED IMPROVEMENT LOCATION: Address: 3-�2 �1 �� Legal Description: POD 2-9 19-r7/60 P COS e R VO L,07- Property Tax ID#: 33 2,7 7 O / Q 0 t 2 O (0 0 Z Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK:' P,01SCE i4 -roty lD KW HEN 7- CRRRI C IndOOr- ?lam! # FE34CrVF9J4CrVF048 oul"do©r M* 24 acc 14 Lf CONSTRUCTION INFORMATION: itiona wor to e e Orme under this permit-check a appy: iVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors Electric 0 Plumbing Sprinklers Generator g Roof Total Sq.Ft of Construction:-?-10 O S . Ft.of First Floor: Cost of Construction:$ !:�-Zip0 UtilitiesoSewerF]Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name W S Name: O C p5 Address: <8 33-2 _ I Fr, d Company: `ru/i nI Coo//tit t hC City: PS& State:FL Address: f rJ`C{-1 S� S I ��(�(f r� - 7 Zip Code: 3 y 2gL Fax: City: JR S L State: PhoneNo.-)-7'Z 6 Z l 6216 Zip Code: '34�25-,2 Fax: E-Mail: Phone No. '2'22 -Z40 737:34 Fill in fee simple Title Holder on next page(if different E-Mail:-reel( y cool v4 CO -1144teo- ('d wl from the Owner listed above) State or County License: Q4C 1 g/6204- if value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: 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: 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 with lender or an attorney before comm in work or recording your Notice of Commencement. s _Sig ture of Owner/Lessee/Agent Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF }( - L COUNTY OF c r The forgoing instrument was acknowledg d before me The forgoing instrument was acknowledged before me this_�_day of 75 N 20by this day of 7::S O\\► 20 \6 by r 41115 e�,, V (Name of person acknowledging) (Name of person acknowledgin ) (Signature of Notary ublic-State of Florida) (Signature of Notary P lic-State of Floridad � Personally Known OR Pro uced Iden>ifi f #ior�as_a Personally Known O ,P �I ,eaOfiic�ati Type of Identification Produced �� V - �`��Q-�F o—`)- Type of Identification P,oddcced .1��� 44- Sia` 11commission No.FE�S$1 ` s � I). Q (`•\�' '\O JCC _ �yy i`'; '.F''Y•p' .an Revised 07/15/20.f14 c •:•�= 4,(�;° s 1` `f REVIEWS FRONT; ..;, `ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS