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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONIALL PWrLILA sLt INFO MUST BE COMPLETED FOR APPLICATION! TO BE ACCEPTED Date: Permit Number: 80ding Permit A pflca i®n Planning and Development Services Building and Cade Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Pax: (772) 462-1578 Commercia€ Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION: Address: Legal Description: Property Tax ID -H: _ �' - Lot No. ? Site Plan Name: Block No. Project Name: Setbacks Front Back, Bight Side: Left Side: DETALED DESCRIPTION OF WORK: 'r (r\ -k�_ CONSTRUCTION INFORMATION: A na I wo rk to bje�errorme un er t is permit- check all t a appy: E HVAC j —_1 Ga Tank []Gas Piping E_ Shutters El Windows/€�o©rs 0 Electric 11 Plumbing Sprinklers E Generator 7 Raaf Total 5q_ Ft of Construction: Sq. Ft. of First Floor_ _ Cost of Construction: $ SE�a� Utilities: Sewer 7Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name Address: C C -i,- :SV Name: Tt E(.Db TUI ll _ Company:Gc-e t cSr>nbt �. [i .5 c.. Address: _JqQ Zaj-�dn Ave - City rt. l.._S'—. C4 F. State_ Zip Cade:'AC(3t.L> Fax: Phone No. E -Mail: City: 6r i _�o�i > 11� _State: rL� Zip Code: S Fax: -??z- 331S -a00 Phone No. 1-71- 3�7"' 3(- e Z Fill in fee simple Title Folder on next page ( if different from the Owner listed above) E-Pllail: + esn�5i5` �u bj o &,-q\ cmc �w _L{l tq+�l .(.OrA State or County License: kw2� I b it value or construction IS �?-5130 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: _ Not Applicable Name: MORTGAGE COMPANY: _ Not Applicable Name: Address: Address: City: State: Zip: Phone: City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: ^ Not Applicable Name: BONDING COMPANY: Not Applicable Name: Address: Address: City: City: Zip: Phone: Zip: Phone: I certify that no work or installation has commenced prior to the issuance of a permit. 5t. 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 your Notice of Commencement. re as Agent for Owner Contractor STATE OF FL A STATE OF Ft DA COUNTY OF ��� _ COUNTY OF,� Theoing jrfffi ent was ocknowledge�d before me this day of 2Yv!\.�2 20 by 01 (Name of person acknowledging 1 (Signatpre of Notary Public- ate of Florida ) Personally Known OR Produced Identification Type of Identification Producecm, _ - v MAFiIAH MILLS Commission No. FF 023763 �= Expifes June 3, 2a17 ��°� �` BandadihmTrayr��InsurancuBQU38r1U19 Revised 07/15/2014 The forgoing ij,4strument was acknowledged before me thi '� day o 201 by (Name of persona knowle—dging j (Signat re of Notary Public- ate of Florida ) Personally Known OR Produced Identification Type of Identification Produced_ _ MARIAH MILLS I £7lission # FF 029763 Commission No. ��. a tx�i es June 3 2oS7 a ,fl �"n, it Fain :u:a6Pi a,lli9l. REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLIF MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITiALS