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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLEINFOMUST BE CO Date: o j y Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 3, Phone: (772) 462-1553 Fax: (772) PLETED FOR APPLICATION TO BE ACCEPTED ICI, �� Permit Number: � � � 0 SCANNED uiIdingIger aAlopIicat ion 1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Tar k PROPOSED IMPROVEMENT LOCATIO.N': Address: �Q Dr. Legal Description: r I--2 -177 n"4-1% . S}q� Q N 1 C p M,, b e�G- ti /Q R- / 7.)�� Property Tax ID #: �{ tf 1 ' ��� li ��� I '• 1��� 5 Lot No. Site Plan Name: ,fin °I Block No. Project Name: V Il ( I U L Setbacks Front Back: Right Side: Left Side: I DETAILED DESCRIPTION OF WORK:, lv,(T� CONSTRUCTION- INFORMATION: Additional work to je ne orme is under -checkpermit a apply: r �L_ HVAC _I Gas Tank Gas Piping _ Shutters Windows/Doors L Electric ❑ Plumbing Sprinklers Generator Roof Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $�Utilities: _ Sewer ElSeptic Building Height: I OWN ER/LESSEE: CONTRACTOR: P Name 6 Name: Address: (� �. �V�i�'I, Company: City: State: _ Address:l Zip Code: Fax: '2') City: 41 Statef_E� I LM4 Phone No. (L� - Q� Zip Code: 3 Fax: 2L-2 - c99( E-Mail: Phone No. 71.2- .21 f 4 L 91o. E-Mail: +T-eAiLsuJe,6c>&Z)4-bicvCWkcD, Fill in fee simple Title Holder on next page (if different State or County License: 0020 from the Owner listed above) r I i If value of construction is 52500 or more, a RECORDED Notice of Commencement is required. I P � Q. 0 t} SUPPLEMENTAL'CONSTRUCTION LIEN LAW INFORMATION _ tV. ..Y�v ,�.t....A. .v,-Y fan? ?t.. -r .� . 3...... '• t� ice { �.L�..� DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: 1 Name: Address: 1 Address: City: 1 State: City: State: Zip: Phone: 1 Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: 1 Address: City: 1 City: Zip: Phone: 1 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'lAssoclation 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 Bui�ding 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, slggs, screen rooms and accessory uses to another non-residential use WARNING TO OWNER: Your failure to Record a 11Notice of Commencement may result in your paying twice for improvements to your pro erty. A Notice of Commencement must be recorded and posted on the jobsite before the first inspectio If you intend to obtain financing, consult with lender or an attorney before com nc n rl<A reifording your Notice of Commencement. re df qfwngr/ STATE OFVFL COUNTY OF s The f Iv*g inst e�t was acknowledged before me 1 this i day of , 20 14 by bl (�Iru a ► l Z . (Name gf-p-erson acknowledging) (Signait?ar of Notar ublic- State orida ) Personally Kno OR Produced Identification Type of Identifica n Pro aced Commission No. (Seal) Notary Public State of Florida Revised 07/ Lucy Juliano NM; My Commission FF 031228 Signature of Co6eact6r/License Hold STATE OF FLORIDt �,�'V`�l 4e /J COUNTY OF — The The for g instru t as acknowledged before me this y of 2014 by (Name o erson acknowle�\g) ` (Signature of Notpry P Personally Known 0 duced Identification Type of Identificati A ced Commission No. I err Notary public Stele of Florida s My Commlision FF 031228 y, 1+ �tp�M1CP Explres o813012017IlAh REVIEWS I SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE 1 COMPLETE 112WN 1 INITIALS I ki T -Vp "I t All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: // �O '' Permit Number: ' 6�3t& "A( RECERVE04,'' Building Permit APp kation Planning and Development Services .APR 1 2016 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: PR�OP©SED INPRO�/EMENT LOCATION: Address: / O9-�v9� O Legal Description: ( I -6a(4&�Pl 1 / Property Tax ID #: '(V' �/l — l ""' 1` 7 �© C'9 S Lot No. Site Plan Name: Block No. /, , / Project Name: (/l/B Ac �(( 1/ � 1 Setbacks Front Back: Right Slide: Left Side: DETAILED DE�SCR PTION OF W0 K: CONSTRUCTION I-NFORMATI N' Acid itiona I work to be pertormed under this permit -check a that apply: —Mechanical — Gas Tank — Gas Piping' : , , K Shutters _ Windows/Doors —Electric —Plumbing —Sprinklers`' Generator _Roof Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ Z ✓��� Utilities: ' Sewer _Septic Building Height: 1 0 NE /LE�S�SEE: CONTRA OR: Name �A/` Name: Address: /O G' S' ©& +• v- f' Company: City:--- ?=­� State: l Address: Zip Code: Fax:r'?S-q)S / z —Os-tG City: ' State: Phone No. Q - S c- 7 — �5 C� Zip Code: Fax: E-Mail: R Phone No. 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. DESIGNER/ENGINEER: Name: Address: City: Zip: Phone Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: State: FEE SIMPLE TITLE HOLDER: — Not Applicable Name: Address: City: Zip: Phone: Address: City: I State: Zip: Phone: BONDING COMPANY: _Not Applicable Name:_ Address: City:_ Zip: Phone: DWNER/ 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 l 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 e'n %At I, or recordin our Notice of Commencement. commenc Signature of Owner/ Lessee/Contra c r as Agent for O rip( :::it Signature of Contractor/License Holder STATE OF FLORID - ';':.:. .,o,,. STATE OF FLORIDA COUNTY OF .�.ti COUNTY OF -Ro a, The forgoing instr ent was acknowledged before m he forgoing instrument was acknowledged before me this ) day of �i,l.� 20 6 by My his day of , 20_ by 44 rn aa) d lez (Name of person acknowledging m N (Name of person acknowledging ) I YJ Alo, R (Signature of Not Public- State -of Florid (Signature of Notary Public- State of Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identific'a i Type of Identification Produced - J�Q' Produced Commission No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 7/2014 _Z SUPPLEMENTAL CONSTRUCTION LIEN'LAW INFORMATION: NEER: I Not App Name: i Address: City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: Address: City: I Zip: Phone: I MORTGAGE COMPANY: _ Not Applicable Name: Address: City: State: Zip: Phone: BONDING COMPANY: _Not Applicable Name: Address: City: 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 tolRecord 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 A�be first inspectio If you intend to obtain financing, consult with lender or an attorney before commi ie�Worko re ording vour Notice of Commencement. re STATE OFfFI COUNTY OF The T!fjrpag inst e! t was acknowledged before me thisday of , i 20 14 by L kra a t1i A P 7 (Name ?f—pbison acknowledging )4 of Notar ublic- Personally Kno OR Produced Identi Type of Identifica on Pro uced Commission No. (Seal) Notary Public State of F Revised 07/ Lucy Juliano v;�i My Commission FF 031 Signature of Cofieactor/License Hold c STATE OF FLORIDIRj� �,.�,p /j COUNTY OF (Y� �V� The for g instru t as acknowledged before me this ay of 2014 by (Name o erson acknowle ng ) (Signature of Notary Pu li Stbte of Florida )"'" Personally Known 0 d uced Identification Type of Identificati o ced Commission No. Notary public StaC3 of Florida My Commission FF 031226 Expires 0a130f20'17 - . ort► REVIEWS SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS