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HomeMy WebLinkAboutplot plan & ob affid All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 21) 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 1N'PRO Ej, ENT LOCA IfJN: Address: (9-m S 1 u'g.V Legal Description: Pay S/Ll 13)-k Z Z.d—J &90- Lf tS C s irl -- An a E 37 Z FT L 7 ,- {' LESS S ,CF —(OZ5 Ak.) CUR 3J48 PL716 Property Tax ID#: �` c -� ot� • 0�• CO®�i' Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: D �TAI LEAD mS�C J'P1'ION � F - O.R�K. '' C AGfJ� V2sal/ /e �/�''��✓� CONST yIJCTI'ON I FIJRNIA ON;: Additional wor to 6e pertormed under this permit-check all tat appy: _Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors _Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ OD Utilities: —Sewer _Septic Building Height: 0\NN,ER L SEE: IN 0' TRACTO : - NameK6nLQ&fl Name: Address: 97 1 ( S &7T4 s Mgf-r- Company: City: Fc?iP.t� State:F Address: Zip Code: 2YCts I Fax: City: State: Phone No. X72- &1 Zip Code: Fax: E-Mail:lq cluean " C:yAqg:I.0®m Phone No Fill in fee simple Title Holder on next page(if different E-Mail - from the Owner listed above) State or County License if value of construction is 2500 or more,a RECORDED Notice of Commencement is required. S.U�PPL�ME,`T�.�[. CONS TRUC1'I® '� [A1lU INFOR ATI �'-' DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: y"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 restrictioris which may apply. In consideration bf the..granting of this requested:permit,.l do hereby agree that l 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. Se Signature of Owner/Lessee/Contractor-as Agent for Owner Signature of Contractor/License Holder . STATE OF FLORIDA, STATE OF FLORIDA COUNTY OFCOUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day o9� � _� ,20 1b by this day of ,20_ by (Name of person acknowledging) (Name of person acknowledging) Signature of Notary Public- tate of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Q9Produced Produced SSO- 2. pcDa.0 Commission No. (Seal) Commission No. (Seal) _ LASHA HNA INGRAM '�: c-State of ori aILANS .x Com .SEc�i; (�bRz 18 VEGETATION SEA TURTLE MANGROVE REVIEWS FRONTS ;_ COUNTCR %'? \`Endeath ouch 7249 VIEW REVIEW REVIEW REVIEW DATE . RECEIVED DATE COMPLETED ev.