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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: !� Permit Number: Cc (fi RECEW D '�0 0 � 7.016 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 1/i Residential PERMIT APPLICATION FOR: G PR�P�SEaD IN,PRO'�VEMENT'LO` TN: Address: O S' D v- r J-,014PA4 3Y95 Legal Description: Property Tax ID#: �(.0D 50- 6 33-®O40-Z Lot No. Site Plan Name: 100 / Block No. Project Name: to r��� S a ted'A Setbacks Front Back: Right Side: Left Side: DETAIL:E°D n ES'CRIPTION:'O:F 1IVORK: C 20n/ 14SAW yr P 1 /©Kti✓ K3 SITRIJCTION INFORMATION: iZechanical a wor to a performed un er t is permit-c ec a that apply: 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:$-zrQ-0 Utilities: —Sewer _Septic Building Height: 0`�WrNE/LE�SE�E: _ CONTRAGTOR'� Name � �5.,' G: Name:; Address: C6 r; -LrAC. City: 14., c _State: Address: U ✓/�e� �`t' - Zip Code: 9 Fax: City: �rS ei� State Phone No. - �,Q� a`l3� Zip Code., 'Y993 Fax:"ZA E-Mail: Phone No Fill in fee simple Title Holder on next page (if different E-Mail C .na from the Owner listed above) State or County License :C&&VD Ltt of construction is 2500 or more,a RECORDED Notice of Commencement is required. MR NSTRl1CTION LEEN LAW INFOftMATI®N: k 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 FLO IDA COUNTY OF COUNTY OF 2 The forgoing instrument was acknowledged before me The fgoing instrument was acknowledged.before me this day of O� 20% by this T day of 20_ by (Name bf person acknowledging) (Naf person acknowledging) (Signature of Notary Pu h-State of Florida) (Signature of NotaQ Public-State of Florida) Personally Known OR Produced Identifica ' Personally Known OR Produced Identification Type of Identification �"ENS Type of Identification Produced LIEGN 3 r'cmm #GG 02202 Produced �— MAR:nNBNS vim MY Cpt,Ah51SSI0N�`16 2020 �'"""ASh OMMISSI4N#GG D21{;23 ra Commission No. t,CPI U pobfwunderv+dtOTs Commission No. .. M I g-08W?w18.2oc? ; Booded fi Bonded Thtu NI Public Underwriter g REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE -MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 7/2014