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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUSY BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: r 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: o�ert �, U�'S //ex vuJ�'s PROPOSED IN ROVEMENI' L©CATION: Address: YW vii 6, 8 �'eP 4 Legal Description: Property Tax ID#: / G� Z�"70( "01 �P_? — Z6n\-,,a Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED /DEQ//S//CRIPTIJOI� CONSTRUCTION IN°FORMATION: 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: Sq. Ft. of First Floor:. Cost of Construction: $ /000 Utilities: _Sewer _Septic. Building,Height: 0 NER/LE�S�SEE: CONTRACTOR: Name oEC -� cw e, i F( evt P.I 0": Name: &4 /,-,)f-ta/=_& O II__ Address:Z / I've gw /4114 Company: O% L• b1 C City: R t�rz-e State:1—k Address/:10/!� S� �rt c✓� �� Zip Code: S y�cl� Fax: City: E�'7 e- Stater Phone No. Zip Code:3�j�S�Z Fax: 772- `7 /5�jq E-Mail: Phone No l 5-M 07<9 Fill in fee simple Title Holder on next page(if different E-Mail? goo .e&jk from the Owner listed above) State or County License 2q 3 7 5_ If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CSN-Iffia IN LIEN LAW IN'FORMATIO'N: 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 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 and posted on the jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attorney before commencing or or, ecordin our Notice of Commencement. e�ofSi atuOwner/Lessee/Agent Signature of Contractor/License Holder STATE OF FLORIDA 1 J ' 6 STATE COUNTOY OF FLORIDA COUNTY OF &A�7_ The forgoing instrum t was acknowledg efore me The forgoing instr ment was acknowled ed before me this Ztday of 20�by this: C day of 20� by (Name of person ack owledging) (Name of person ackn ledging)lip ` ' J (Sig tot' tary Pu - lorida (Signat - F r' a Notary Public-State of Florida , ,,,`aJA * � ,,°.P �a�,,� ANGELA M HUFF . 1 / Pers' ", Commis rFF2347 ri ification V Person °' Notary 6�140r Sd�tee�9'Wevii cation V 9, fly-EarntrrE c r s�lay��l SMS • "A. o mission#FF 234730 Type;of td� t at��ed through National Notary Assn. Type o cflr a9rM Produced = Produc' d�����;/°FFI�p�� Y Comm.Expires May 27,2019 aiona otarygssn s` Commission No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.