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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: /G r Permit Number: 1Iacs- 63(�a RECEIVrD QCT 2 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: :,�' " • Yxg*tE'AkAt Yra t ��e �;,' hp WWI .. PR(}POEDINPkROVEMENT LQCATION`� M 4 F ;� ,f r . . .-.:k r .__... ,y a_Wd. ...:.:.Nom Address: t= G Legal Description: Property Tax ID#: c�.�1� • � �`T' ©�©' Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: ✓ Left Side: �DET�AILE�D DE GRIPl"IONy�C+LF�WO�RK ,° £ ,���' kIII Id III I sit CONST�RUCTIONF:QR ATION E .�:, � � r Additional work to be pertormed under this permit–check all tat appy: _Mechanical -Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric –ol'umbing —Sprinklers —Generator —Roof Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ VI 030 Utilities: Sewer _Septic Building Height: OWNESSE: CONTR '§Tp�R; r r Mm+at .wFi " Y.E.R'ar ..s4.� .h.: ..r„� .�:. _,+ .:nn�„ J w'&�rv`ea.ih 'iu74u; R:'Ay,'`..�• NOR Name; SOG� Name: Z r/Gy1 Address ' %0- .:�. svt2 0 Company City: Iedyi' State Address: .. :S Zip Code: `3 City: v'_7/PI C1. .`:: State: 9 Phone No. 'O Zip Code: rjjy��' Fax: E-Mail: ��o I `7G `�li T Phone No '771— 157-7! d i 3 :?2 Fill in fee simple Title Holder on next page (if different E-Mail &L'//W/)-A_' 05;) 4,Z �c,.N from the Owner listed above) State or County License ,17 F e O 3 3 � if value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SU'PPLEMNT�AL. CONS�TR � CTION LIEN LAW IN'F`ORI111ATI � 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 commejicing work or Wcopding your Notice of Commencement. Signature of Own e /Less a Contractor as Agent for Owner Signature of Contractor/Lice se older STATE OF FLOJ2IDA STATE OF FLORIDA , COUNTY OF 1.0 c. \F—' COUNTY OF The forgoing instrument was acknowledged before me The fopoing instrument was acknowledged before me this' `!> day of , 20AG by this 4ZD day of d C* 20A by (Name of person acknowled ng) (Name of person acknowledging) (Sig ture of Notary Public tate of Florida) (Signature of Notary Public tate of Florida) Personally Known OR Produced Identificatio Personally Known OR Produced Ide n Type of Identification G �SpIs Type of Identification ABG SU23 Produced �� �� �,G��,zpzo roduced TC L 1� v MPRN0GGo�Zo pa�,s. V�deN� Commission No. c ` OQob�` Commission No. y"� •., „gyp\ No, i� .za �pded�' r$' •,�;� YJ'dC� i,, ... REVIEWS FRONT SUPERVISOR PLANS VEGETA SEA TURTLE MANGROVE COUNTER EW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. Fort Pierce Utilities Authority X61100 9-coo':5 "Committed To Quality" J Water/Wastewater Engineering S 206 South 6th Street Phone(772)466-1600 Ft. Pierce, FL 34950 Fax (772)461-1938 CUSTOMER INVOICE (ESTIMATE OILY� r QUOTE FOR: TIMOTHY A BLEDSOE >.: JOS 1 E CIR[PTION: INSTALL NEW 5/8 x 314 WATER METER' INVOICE NO: BORD00002962016 PREPARED BY: WARE LOCATION ID: 10006799 ADDRESS: 958 REVELS LN FORT PIERCE FL USA 34982-6677 ADDITIONAL INFO: (561) 762-5764 UNlfIFCOST u _ c.3; •. -e"`�..I , .'.1.. ,.S?. ..._:,..vtk,irc_v rl . .r.`.�.,..�' ..t:' ..,. 1I .� ::. ,.i...: .. ' W-3/4 WSVC U/G WATER 314 METER/SERVICE U/G 1 $800.00 $800.00 W-CAP IM CHG WATER CAPITAL IMPROVE CHARGE $0.01 $644.35 W-CON FEE NEW WATER CONNECT FEE NEW CUST $0.01 $40.00 DEPOSIT INVOICE DEPOSIT FOR INVOICE NEW CUST $0.01 $60.00 TOTAL CHARGE $1,544.35 Customers will be assessed wastewater charges the day they connect to the wastewater system or within 365 days from date wastewater Connection..Charge.-Is paid - whichever is first. The cost of the service line from the point of delivery at the property line to the house/building is the responsibility of the customer and is not included in this invoice. State laws require that a permit from the Health Department must be obtained prior to initiating a septic tank abandonment.Contact the Health Department at (772)873-4931. Constrilction�bgst estimates,are based on current labor, equipment and material prices. Actual costs of construction will be determined at the completion of the project. ShOMId unforeseen circumstances be.encountered during construction, including but not limited to adverse weather"conditions- and constructf& conflicts, the customer will be.responsible for increased costs. Additional costs incurred by the customer shall not exceed fifteen-(15).percent of the total estimated constructiori:Costs shown above. Estimated costs paid by the customer that exceed the actual cost of construction will be refunded by Fort Pierce Utilities Authority.All fees are due prior to any construction. Note: This is only an estimate. A bill will be provided following acceptance'of the Customer.:invoice-once signed and dated. Please submit accepted Customer Invoice to Customer Service at 206 S 6th Street, Ft. Pierce, FL 3�0.;ar`call (772)466-1600 to setup an Customer Signature: Date: g s r Printed Name: Yy PAGE 1 OF 1 PRINTED ON: 12/30/2015 AT 03:35 PM