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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE CO R ETED FOR APPLICATION TO BE ACCEPTED`,' Date: Permit Number: REC, A f ___..__...._..... Van Building Permit Application FEB 2 4- � d� Planning and Development Services PER WI:t7i;�=� Building and Code Regulation Division St.Lucre L"<:';" 2300 Virginia 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 7-- �5�� Property Tax ID#: ✓� ! oC --o 65 ©a a -- 'Z Lot No. `! Site Plan Name: 15! 6A ia� do �� ����Gc Block No. 6- Project Name: c Setbacks Front -2-,� Back:- �, ! Right Side: Left Side:777717777 DETIE6 DESC �P r R TIC}N QF WORK �� x CONSTRU'CTIOIV 111`lt=0Rl1%lA 'ION r +u3`'.,: itiona workto e e or me under this permit-check a a pp Y: EHVAC _Gas Tank ❑Gas Piping _Shutters Windows Doors O'Electric ®-per / umbing Sprinklers �Generator E]Roof Total Sq. Ft of Construction: S . Ft.of First Floor: Cost of Construction:$ � �� UtilitiestSewer ElSeptic Building Height: o dt icy- Name: v�A-�E' 'w Address:__ ��� ���ss sr Company: ��e v2,�-T� �✓pdG�' . City: State: E— Address: l 'of�. r�s-/ Zip Code: Fax: City: State: Phone No. Zip Code: V_2 uZ_ Fax: E-Mail: Phone No. f 7> _ \ Fill in fee simple Title Holder on next page(if different E-Mail: 49Z_CezJ 4i�T&_ aa/ 57 from the Owner listed above) State or County License: G i� z 7 If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. r - - SUPPMEMENTA`L�C{)NSTRUCTION LIEN LAIN INFORMATION 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: 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 copime.ricing work or recording our Notice of Commencement. o •c�-e�_ ,,tom ✓�� s _ Ignature of Owne: es e/ gen Signature ontractor License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF J- Lu Gi @, COUNTY OF �fi i„A i CA-X­ The forgoing instrument was acknowledged before me The Vday Ing instrument was acknowledged before me this�day of J)etGy bAA__ 20 110by this of eLL 20 11 by (Name of person acknowl ging) (Name of person acknowledging) ' (Signature of Notary Pu c-State of Florida) (Signature of Notary ublic-State of Florida ) Personally Known OR Produced Identification ✓ Personally Known FOR Produced Identification Type of Identification Produced'CL Dt. LS5Z 1170 1J zZu Ty a of Identification P o u d Commission No. ,,.;;'aYP�e,,� ( FALLON TUTHILL ,.� 9Pie,, FALLON TUTHILL `�•; t�glldy Public-state of Flor dC mmission No. Notaryww)-State of Florida •; ; Commission+y GG 03280 N :•= Commission#GG 03290t • QeSep v. M Comm.Ex i►es Se Bonded through National Notary Assn. "' Bonded through National Notary Assn. p.• Revised 07/15/2014 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS