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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION (2)ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: r.2 u2F: A. Permit Number: Building Permit Application Planning and Development Services Building and Code Regulation Division, 2300 Virginic Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III PROPOSED IMPROVEMENT mc"'- 1" I Address: ';f 00 (i ( rk 1)t" ✓t Legal Description: I octet S 11 I2 e 41-7 Property Tax ID #: Site Plan Name: Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: Lot No. Block No. ?V\\ \rte 4�m kJ ^�r` WTP``JG'71Tf5 Tti(%JJC� 'Irt'c ZJelA'I Name: ':S .S1 cin' fro,, V'�. e'er i 5 i1 ^ � ` o- k-\ �'o }�..4- YV \-L.a,v r^� C.l 6 1-4Ae-A- 'J, d oc vk CONSTRUCTION INFORMATION: _ HVAC Electric _Gas Tank Plumbing Total Sq. Ft of Construction: Cost of Construction: $ Aga _Gas Piping —Sprinklers _ Shutters _ Generator Sq. Ft. of First Floor: —Windows/Doors _ Roof = Root pitch Utilities: -Sewer _Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name -i Name: ':S .S1 cin' Address: .rt Company: AwIn6 .Z1tC City: Por+ $j. --kc.c State: ELL Zip Code: S,el5 Fax: Phone No. Address: 114{1 i 4f'-40' 6I1 City: r:lr� t A --'.e Zip Code: 3`198a Fax: Phone No. %72— ,4/G— state: ! c A/l.4 51502 E-Mlail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E -Mail: OW:Me-; aG L li"ca 5� : •�� State or County License: e24-2 If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: j�_-e 1nG�JS�b DESIGNER/ENGINEER: Name: _ Not Applicable MORTGAGE COMPANY: Name: _ Not Applicable Address: JASON M RAULERSON '''°• "e•a JASON M RAULERSON ¢ Address: City: Zip: Phone: State: City: Zip: Phone: State: FEE SIMPLE TITLE HOLDER: Name: _ Not Applicable BONDING COMPANY: Name: _Not Applicable Address. Address: 21P VEGETATION Cay: COUNTER City: Zip: Phone: DATE Zip: Phone: 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 ermit holder to build the subject structure which is in conlYlict 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 commencine work or recordine vour Notice of Commencement. as Agent SPATE OF FLORIDA COUNTY OF si, r i- The for oing instrument was acknowledged before me this 0dey of L¢.r+Lx- . 20 1,i._by SWE OF FLORIDA � COUNTY OF �+u . L_" P The forgoing instrument was acknowledged before me this"dayof / >F'cP,/n�aP/ .20 If,, by i� �qT4 wi` LA_k'2 j n'S4a _ " (Name of person acknowledging) (Name of person acknowledging) (S" ature of Notary Publio- State of Florida ) Personally Known _I OR Produced Identification Type of Identification Produced (Sign re of Notary Public- State of Florida } Personally Known s� OR Produced Identification Type of Identification Produced Commission No. j�_-e 1nG�JS�b (Seal) Commission No. Pp 1146 (Seal) Revised 07115/2014 ,G P`e`N's JASON M RAULERSON '''°• "e•a JASON M RAULERSON ¢ Not public - St . - State f Fl Notary Public -State of Flor M commission M FF 65546,�?� co REVIEWS FRONT 2 f y".fftV0f FFe 21P VEGETATION COUNTER IE REVIEW DATE COMPLETE INITIALS y \^ ^ / �?©� � ` < � \ . . . . : - %2 e. . , Rl A ^ \�