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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE 1 FOM MOST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 'C Date: v� �'� �SO 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: IRRMRWMMSKED 1N�EMENT LOCATION: Address: Legal Description: d�c.T- ��r' k K LdT 7 Property Tax ID#: c�-� oZ f - (03~-V Oc7� Ooh Lot No. Site Plan Name: CS 0 e S�or:� �p S ��u C� Block No. Project Name: 52 NA Setbacks Front Back: Right Side: Left Side: ETAI ED " PTI CON-TRkUCT O IN 'QRNIA 10`N: Additional work to be pertormed un er t is,permit-check all that appy: —Mechanical —Gas Tank —Gas Piping —Shuttersindows/Doors Electric Plumbing Sprinklers Generator; I/ Roof Pitch — — g — p — — Total Sq. Ft of.Construtn: c-1D Sq. Ft.of First Floor:.: Cost of Construction: $ (cam 6 c_�O Utilities: Sewer —Septic Building Height: OW UER/'LEStiS E. CONT'MANNITWO,R. Namet.Q,6, Name: 7 TC5(.,_V,, (�%A'Ak-C*L/_ Address: a' tj CL r Company: City: -3 T'Pl_�n__e ._ /, State:7/ Address: -7'?O ) C.��r•c,.s C��'Zip Code: IZ1944 ? Fax: City: -7r, ptoL_p State: 7/ Phone No. 1. ? 2. tT _2�j Zip Code: 3 q 9.S l Fax: �It0--01_7 2- E-Mail: �' Phone No Fill in fee simple Title Holder on next page(if different E-Mail�q�.c�.wv.�v--r-©o_" ® A C-t-L.A,Co 00, from the Owner listed above) State or County License C 02, 1 33 ©SCA If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLET ENTALROMNS CTION LI .N LAW INFOR'MATI'ON: DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLEHOLDER: _ 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 commencing work or recording our Notice of Commencement. ign ure of Owner/Lessee/Contractor as Agent for Owner $Signre of Contractor/Lice se Holder I STATE OF FLORIDA LSTATE OF FLORIDA COUNTY OF a,c:� COUNTY OF The ing instru e t was acknowledg before me The fQr oing instru nt was acknowledg d before me this day of 20 by this ! day of 20�y © 0, (N me of person acknowledging) (Name of person acknowledging) phtla N_V 6 A- N (I a"j & ignatur tary Public-State of Florida ) (Signature of Notary Pub c State of Florida) 7 Personally Know OR Produced Identification Pers Wally Known OR Produced Identification Type of I n ype o e roduced Produced �.� vP;;a,, ANGELA M HUFF S qy PV, ANGEtA HUFF :_ Notary Public-State of Fiarida Notary Public-St a oflIf�lorida Commission Nd °�« : Commission#�r �)730 Commission D.•�• .? ission#M� 11730 rt,ttmm.Expires May 77,2010 My Comm.Expires May 27,2010 ° Bonded through National Notary Assn.' REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW _REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.