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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST 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: PROPOSED INPRfJUEMENT LQCATION: Address: f �� Qy It-oyi Rd- Legal Description: Property Tax ID#:�'Z rU 327— L1002 000 0 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: OETAI ED DE�SC�dPTION Of 0 K: 1N'�V e e f� 1 hilr` Id��►c+ ds terdwaW "W o W � -h /00aphe fepv.ce,recg. dkd CONS RUCTIO INFOR+ AT ©N: itiona work to be peFformea t is permit—c ec a tat appy: /Mechanical _Gas Tank _Gas Piping _Shutters " _Windows/Doors v Electric _Plumbing _Sprinklers _Generator _Roof Total Sq: Ft of Construction: Sq. Ft. of First Floor: Cost of Construction:$ j 4C D4 0 AeC Perm fi Utilities: —Sewer —Septic Building Height: UNN191 E : CONTRAC ®'R Name 1'`� d viQf-1 �• I1 ut�i oS Name: DdVt ��V12 Address: 102- E. 5_fd�i041 Ove Company: �1/iot Cle,Evac_ Jkic . City: C00h81'S1iH!�r State: p# Address: . J 6ux lZ9�5 Zip Code: /D U� 3j6 Fax: City: Ft, �*erce State: IrL Phone No. U O Ef7— 9 16 q „Zip,Code: 3�f�J y 9 Fax: E-Mail: Phone No 77 Z �'7-9.` Fill in fee simple Title Holder on next page (if different E-Mail from the Owner listed above) State or County License E K -Ud I F30 Ef of construction is 2500 or more,a RECORDED Notice of Commencement is required. J' IN 11 1SUPPLEMENTAL fflTgM1,0'N'1LIEN LAW E IA 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 your Notice of Commencement. yc Z- -V-1k 4Z4V Signature of owner/Lessee/Contra Agent for owner Signature ZofCo—ntractor/Li—cens?Holder STATE OF FLORIDA_- STATE OF FLORIDA COUNTY OF COUNTY OF �A"A -0 The forgoing instrument was acknowledged before me The forgoing instru mat wa6 acknowledged before me"-' thisD day of 20 by by thiiCn day of .20 1.0 by (Name of person acknowledging) (Name of person acknowledging) Sign Lure of Notary Public-Sfbte of Florida (�-ignature of Public-State f Florida Personally Known OR Produced Identification Personally Known_OR Produced Identification Type of Identification Type of Identification Produced Produced Commission No. Commissi, t ASHAHNA IWGRA(Seal) Notary Public-state of Florida. LASHAHNAINGRAM State of Florida 4", Notary Public Mv Cc m.Wires Dec 20,2018 My Gomm Expires Dec 20,2-01 Com fission#FF 177249 REVIEWS FRONT PLANS VE GETATlGftedlir6JAN*0gJ4t1ETyA,, ' n�­ - NGROVE COUNTE "R @Wed thrc ugh tkMIF"ry EVIEW R EVI EW;—,----z'9RE EVIEW --b-A—TE RECEIVED DATE COMPLETED lev. /IZU14