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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -Date:_ Vis.-���/� Permit Number: , 71501572- �:f�. .. �,� �1'=D OCT 2 5 7616 `�-' � ` �" RECEI �: R 1.11.11 1 IN1. Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce A 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: PROP0-, N P1T LOCATION: Address: k6/W s Legal Description: Property Tax ID#: DL4a.I Q©12. ©lX 1 .5 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: ✓ Left Side: DETAILED DE�S;@�RI-PTIO v ul GZU7+i1 r�� -72;2 CONSTR,UCTkON I'NiFO =MATION: Additional work to a pe orme under this permit-check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric t-'151umbing —Sprinklers —Generator —Roof Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ 4d. Utilities: —Sewer _Septic Building Height: OWN�ER/LE�S�S�E� : C®'NTRAC�TOR: Name -771j 0 , Address: l0 Company:. City: /L �L� State/G All '' DMOP Zip Code: Fax: City:_poi :QED State: /C(. Phone No. Zip Code: 3`L9 -'Z' - ;Fax: E-Mail: Phone No 7- Fill Fill in fee simple Title Holder on next page (if different E-Mail from the Owner listed above) State or County License 7?2(5/.5— If 2(5/.5If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL C«®NSTRUCTI®N LIEN LA"W IN`F®`RtIVIATI '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 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 commenci work or rqcordilig ypur Notice of Commencement. ignature of O%{ner/Lessee Con actor as Agent for Owner rgnature of C ntrac or/License Holder STATE OF FLORI A STATE OF FLORID COUNTY OF COUNTY OF J;'. The forgoing instrument was acknowledged before me The for oing instrument was acknowledge before me this�-� day of C�e� , 20W by this day of CtL—%G ,20�G by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Public-Mate of Florida ) (Signature of Notary Pu c-State of Florida) Personally Known OR Produced Identification Personally KnownOR Produced rcatioi Type of Identificatio \�4Type of Identification ��c,NEN5p2:; 1 Produced "1- �^ UNs Jzs Produced L 1., 4 6?20�`�, . A Commission No. d E Gob �e Commission No REVIEWS FRON `IUI SUPERVISOR PLANS VtGET7MON SEA TURTLE MANGROVE COUNT REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 5 a� 7100/9 ©o0 5 Fort Pierce Utilities Authority "Committed To Quality" j r - Water/Wastewater Engineering 206 South 6th Street Phone(772)466-1600 Ft. Pierce, FL 34950 Fax (772)461-1938 CUSTOfMER,INVOICE IESTIMIIaIITE QNLY) 4UOTE FOR TIMOTHY A BLEDSOE JOB;'CIESCRIPT{ON INSTALL NEW 518 x.314-:WATER METER ONLY NQ SEWER INVOICE NO: SORD00002952008 PREPARED BY:WARE LOCATION ID: 10006798 ADDRESS: 956 REVELS LN FORT PIERCE FL USA 34982-6677 ADDITIONAL INFO: (561)762-5764 TASKS': DESCRIPTION COUNT;' . UN{TCOST CHARGES W-3/4 M/SVC U/G WATER 3/4 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. Construction--cost estimates-_are tiasdd ort current labor, equipment and material prices. Actual costs of construction will be determined at the completion of the project. Should unforeseen circumstances be encountered during construction, including but not limited to adverse weather'conditions-and construction 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 construction costs shown above. Estimated costs paid by the customer that exceed the actual.cost"of construction will be refunded by FortPierce 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,Jhnv ioe'once signed and dated. Please submit accepted Customer Invoice to Cu Service at 206 South 6th Street, Ft. Pierce, FL 34950.or call (772) 466-1600 to setup an Customer Signature: Date: Q Printed Name; PAGE 1 OF 1 PRINTED ON: 12/30/2015 AT 03:32 PM