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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I p Date: Permit Number: 1 lLQl I- V4 I e Q � w € t -- _ Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 I, Phone: (772)462-1553 Fax: (772)462-1578 Commercial I Residential I' PERMIT APPLICATION FOR: PROPOSED INPROUEMEN,TLOC'ATI'0'N �. .,. Address: Legal Description: Property Tax ID#: 21-1 oa- (DO& CQ 1 • 000Q Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: fl TK�.1p �s Wow '�rfkN�Of WORK �� _:, 4�„ 7 :,, $� . fl ,.a ., �a :' ,. �w. b I To 17 ))q II is IM my CONSRUCT}IOOO4NINFORMATION2iu� � �top it rF Additional wor to be performed r under this permit-check all that appy: —Mechanical —Gas Tank —Gas Piping —Shutters _Windows/Doors —Electric •�umbing —Sprinklers —Generator — Roof Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction: $ 00 Utilities: Sewer Septic Building Height: 011V'IER/LESSE; LGONTRA , OR'' i,�K. i..r.v..yat, 45�,'i�?,x c", - Name AF-K- Name: Address: O-6 1 e-X 6 91Y 7�)4111 Company: City: r y �D� ! ��2C_�. State: > Address: i Zip Code: Fax: City: State: Phone No&o,Q , ' 1x0 3 Zip Code: ' Fax: E-Mail: T M C' V(M Phone No Fill in fee simple Title Holder on nex age (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. I �i SIJPP'LEMENT TL CONSTRl1;CTl®,N LIE 1LAW1INFORMATION .. �, 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 FLORIDA COUNTY OF ��:h �_. COUNTY OF The f r oing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of Q.r�y 20�( by this day of 20_ by (Name of person acknowledging) (Name of person acknowledging) —(SO kturle of Notary Public-State f Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification n Type of Identification Produced O_A-rC6, glfl'I Z�•b�� ( o lueed LASHAHNA INGRA�1 "' t*0ehf_M9 q No. (Seal) Commission No. Seo *� Notary public pec 20. M Ex it `f- Y is sion FF 177249 1'�1Tea ondedthrough Ilona o a REVIEWS FRONT ZO G� VEGETATION SEA TURTLE MANGROVE COUNTER REVI REVIEW REVIEW REVIEW, REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. //2014