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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date• Permit Number: Building Permit Application MAY 0 2 201- Planning and Development Services Building and Code Regulation Division - FEcpdil7 St. Luci CouLntynty, FL 23W VirginiaAvenue,.Fort Pierce FL 34982 T, Phone:(772)462-1553 Fax:1772)462-1578 -Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION Address: I J.it C, ri ri Legal Description: Lc�. L S : rcft PropertyTaxlD#• �`� ..' t " 1 l" © Lot No. Site Plan.Name• Block No. :Project Name: ,o Setbacks Front Back: ) 'Right Side: Left Side: DETAILED DESCRIPTION CONSTRUCTION INFORMATION _.._ Additional-work toh o e orme un erthis permit—checka app y: E1HVAC Gas Tank ❑Gas Piping -- _Shutters []Windows/Doors Electric Plumbing Usprinklers Generator LJ Roof Total Sq.Ft of Construction: % (! .Ft.of First Floor: Cost of Construction:$ ��'l �! Utilities:Sewer Septic Building Height: OWNER/LESSEE CONTRACTOR } Name 1, r, ,p - Name: C, ;ti . Address: 3 f f (1, t��s Od �_ a! , Company: f4 c c. ley State Address: CO3 M tt-- Tap Coder Iq `7 d— Fax: City: Ffi 1 ir� State`` FL Phone No. '7 �- �:.7 ,,�-<<�.S� Zip Code:3�4l 6r • Fax: 7 7 a 761v My E-Mail: d Phone No. Fill in fee simple Title Holder on next page(.if different E-Mail: re �cI from the Owner listed above) 'State or Coun 'tense: R If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. (. DESIGNER/ENGINEER: _-Not Applicable MORTGAGE COMPANY: Not Applicable Name: Name- Address: Address: City: Stater City: State: Zip: Phone: Zip: Phone: FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable Name-' Name: Address: Address: T. City: City: Zip: Phone: Zip: Phone: .1 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 withyour Home Owners Association and review your deed for any restrictions which may apply. In consideration of the:granting of this requested permit,I do hereb%a-gree that-I will,in all respects,perform the work in accordance witifthe approved plans,the Florida Building Codes and St Lude County Amendments. The following building permit applications are exempt from undergoing a full concurrenky review:room additions; accessory structures,swimming pools,fences,walls,signs,screearooms nd 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 prgperty.A Notice of Commencement must be recorded and posted on the jobsite before the first inspection.if you intend to obtain final tong,consult with lender or an attorney before commenting work or recording our Notice of Commencement. Signature of Owner/Agent/Lessee Signature of Contractor/License.Holder- STATE OF FLORIDA STATE-O F ORIDA l COONTYOF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged-tlefore me- this day of -2o by this::day of YY llA 20_by (Name of person acknowledging} (Name of person ackno a (Signature of Notary Public-State of Florida) (Signature of Notary Public State of Florida) / Personally Known OR Produced Identification Personally Known OR Prod Identification ✓ Type of Identification Produced Type of Identification Produced -Commission No. ( 66W (Seal) Commission No. / I<AREN S-: NIEL_SEN `n Commis S FF 115637 o� - ._ M Commission # FF 115637 s y Commission x Revised07/15/2014 '� ,� My Commission Expires %�,'�'E�F���� JUne 1 2, 201 8 '����f Uf fU�d June 12, 2018 Illlllf REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION ' SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLE?E 61tJ .INITIALS -