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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 15��� Permit Number: . �^ W1 .f ' `. RECEIVED JUL 151016 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 X PERMIT APPLICATION FOR: PROPCISED INP'ROVEM`ENT L®CATI©N: nn Address: ti 5 It L3 rN Z)r � Yi��C� FL`s g Legal Description: Property Tax ID#: �J�C�a-��`�-d`-{ I� �C)o-- I Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Co.S' Right Side: Left Side: ®1 F WORK: CONSTRUCT�@NNFORMATION: Additional work to be pertormed under ME permit-check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: 12 t7 Sq. Ft,.of First Floor: i Z-0 Cost of Construction:$ Z(;On Utilities: —Sewer, —Septic Building Height: g 0 NE=R/11ES`�SEE: CONTRACTOR: Name v►icl 4140P=\- Name: gl Address: Company: City: State: - Address: Zip Code: 3 Lf',W? Fax: 772- *6,-)-24C*214 City: State: Phone No. '722 dl7/ctt - 'D- 55-' Zip Code: Fax: E-Mail: GYo►h mot' i Ala �Oa3 -tt,.tie,-f 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. SUp'P�LEMENTaL CONSTRUCTION LIEN LAW INFORIVIATLON: 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 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 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 6Y. COUNTY OF The fojgoing inst Wnent was acknowledged before me The forgoing instrument was acknowledged before me this\ day of Jyl y ,20�Z by this day of ,20_ by lic\ \ V'�a c � -�\ (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary PubliV State of Florida ) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification #Personally Known OR Produced Identification Type of Identification s �ype of Identification Produced L Q — pEANNA GtVENot F�or1d Produced State g Commission No. drUx`cytePmbExPn#�E S5g16N1 51C :mmission No. (Seal) `��O �r �ommiss'o nalNolacY °� rough Na1in, REVIEWS FRONT ' ',rZO'N:: SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE R COUNTEREVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 120114