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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION. - .4 •�•.. � M 4. r All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: l'-r 3- jam^ S � �a Y� -. RECEIVED r S W7t�a��Ac'tXs'k;ya� rt �9�,�� + Building Permit App� IlicationMAR 31 2015 Planning and Development Services �;� „ (I �-�„� yr7� r�� SCANNED Building and Code Regulation Division 4 C i.0 C lJ /S�� BY 2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie CUUnr Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: Address: Legal De S �4 4= o - i.C.y "'�nc:p A!X v Property Tax ID #:Site Plan Name: Project Name: 9�L6 Setbacks Front Back: Right Side: Left Side: Lot No. Block No. Huur, UJI4l w_ ui K ru ue per 1U1 nreu wruei inn perms—cneLK du;uiar.appry: ('Mechanical _ Gas Tank _ Gas Piping i `"- il- Shutters _ Windows/Doors Yip r i; Zi.Electri - _ Plumbing _Sprinklers ;- ._ Generator _ Roof Total Sq. Ft of Construction: ` Sq. Ft. of First, Floor: Cost of Construction:r$ 1 � Utilities: _Sewer _Septic Building Height: NE LESSEE:Q TRA[TOR: - Name (�> cc.� Name: //Y//jS Address: 2rap \iot\©R.c� )' ' W Company: 0 2r hf N P /a , rr-1� City: 'Lracr State: >rl Zip Code: 2 01191 Fax: Phone No.-7i2-q'1I-V$05 Address: KaV. i` J8N4f City: AVPZ; Stater Zip Code: X740,1 Fax: Phone No E-Mail E-Mail: (P� 00- Q�'Uk AN14� Fill in fee simple Title Holder on next page (if different ' from the Owner listed above) State or County License If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. BARIPIMAENTAI CONSTRUCTION LIEN l AUV I(} MATION: DESIGNER/ENGINEER: _ Not Applicable Name: ' q fa MORTGAGE COMPANY: = Not Applicable Name:, Addressn ^ - "cfne a Address: City: y�WF ',e z State: - _ Zip: 3;aso Phone - 60 7 City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: of Applicable Name: BONDING COMPANY: _Not Applicable 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 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 atfomey before commencing work or recording our Notice of Commencement. i 4 ;��92 �� A�,� Signature of Owner/ Lessee/Agent y Signature of ContrVALicense Holder�(�(/\.�'@j��''' to STATE OF FLORIDA s STATCOUNTY COUNTY OF �� OFOR The forgoing instrument was acknowledged befo�� �� The forgoing ins ument was acknowledged before AJlby this day ofPi/7 20 /� by m this day of 20 3 m WAS CC YLaz C �w�/a PA 'At VVVI..� , (Name of person acknowledging) a (Name of person acknowledging) a ZJ Signature of N ry Public-Ttate of Floh a)V ( gnature of NAary Public -State of Florida) Personally Known OR Produced Identification Person all wn OR Produced Identification Type of loenTrf Y n Type of dentifi you Produced ` Produced (Ci CI Commission o. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW DATE �3 RECEIVED WREVIEW DATE Or COMPLETED Rev.//ZU14