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HomeMy WebLinkAboutBuilding Permit Application ' 1 All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: 101 ICA, . -t,. :; 6 y •; w F 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: PR0:PC}20 1lUP:FtC?VEME'!UT LOCATILW,(U: Address: $75 I 6T NIS6t05 a, 53rrf 0e -re 4 'S: Legal Description: Property Tax ID#: ago j_tP0�— ©©�{ 000—Z. 1 Lot No. Site Plan Name: Black No. 46Project Name: � , Setbacks Front Back: Right Side: Left Side: DET ILE� D'E�-SCR P 0 A F V1/OR CONS`fR+U'CTtON IN'FOR{10,ATI'@ Additional work tone performed under this permit-check all that appy: ^Mechanical +Gas Tank ^Gas Piping _Shutters _Windows/Doors Electric _Plumbing _Sprinklers Generator _Roof Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ AEO- Utilities: —Sewer ,'Septic Building Height: OVtVN1ER LCQ'NTIAC NameName: Address: fii,41swu Company: City: A, Gr-4 At eae State: -- Address: Zip Code: *3ggS`1 Fax: City: State: Phone No# 1.0 - y,-002z- Zip Code: Fax: E-Mail: / l 601-1, l( �� D�Com Phone No I 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. i t 5U!PPLEf�IENTAL CONSTRUCTION LIEN LAW I�NFOR'MATI.®N: DESIGNER ENGINE R: Not ApplicabliMORTGAGE COMPANY: _Not Applicable Name: tt!�ie u�tsr ,�'r�ec� S� Name: Address:-W Address: _ City: /e%TState: City: State: Zip: Ei q ' Phone cit 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 Jrecording our Notice of Commencement. Signatures U@v' 'r/Le ee ontractor,as Agent for Owner Signature of Contractor/License Holder . STATE OF FLORIDA 1 STATE OF FLORIDA . COUNTY OF •V.r�x�C,sL_J COUNTY OF The for oing instyment was acknowledged before me The forgoing instrument was acknowledged before me thisday of_ 20l 1 by this day of 20_ by ( e f person ack wledging) (Name of person acknowledging) ign ture of Notary Public-Sta of Florida) (Signature of Notary Public-State of Florida) Personally Kni", — OR Produced Identification Personally Known OR Produced Identification ` Type of Identia�lo�Y�,,, Type of Identification Produced +°. `°;: LA Produced A INGRAM 3� �+. My Cp y 1'ubli°-S t Commission o' ;oPc mm•Expires%05Florida Commission No. (Seal) mmissio 0 2018 Bonded thro° p #FF 177249 °tar I Assn, REVIEWS FRONT ZONING � =ERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.