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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMFLt i ED FOR APPLIIATION'TO BE ACCEPTED Date: it Tzs- Permit Number: RECEIVED --- — — --1110 Building Permit Application" 3 0 2015 Planning and Development Services SCANNED Building and Code Regulation Division BY 2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie County Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: PROPOSED INPROMEMENT LOCATION: Address: 2%1 et Tctyn-rfgd 'i (- Fs '{�ctrc� FL. Legal Description: (Dri i R,oeF arMrd AS U h i r 110 Property Tax ID #: Atp 612 6 60 3 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back:- Right Side: Left Side: q;'�NK�i-n 1I ti � ✓Y I,t1G f-)•y �.-o,�� O/in2 i. 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: $ 3S o' Utilities: —Sewer —Septic Building Height: 02=LIESSE-E: CONTRACTOR: Name Imr .{ wrs Qoktir�i J,/4GXwr Name: mrc1irz(_ Sufi&Q rszD Address:!J91V 4W 1Aet 4t6vY Cfir Company:_`7Fya..,C'r�CDnStwra•F)J„ /rill( City: 0 aI_ Cf�Y State: Zip Code: 34A4a Fax: Phone No. Address: Vgtecl ]-/JInv SovHY Pth-e City: _FT_ tirt,4C,-L Zip Code: 2>%Jq 4 r Fax: 771- Phone No '772_ ?vl '77d1 Stater yb 5- 7 87 3 E-Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail © Cto L . eo '4 State or County License b o2Q00 362 If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL GQNS 19 N LIEN LAW INFORMATION: DESIGNER/ENGINEER: _ Name:/'& U_ i rt 4"1& Yq � .. Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Address: 9in17 �)yCett..arL a.,^e Address: City: f t- NDrc rvL Zip: 344Sz1 Phone .-772- State: Gc- q n -77 S7 City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Name: Not Applicable 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 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 recordins vour Notice of Commencement. po Signature of Owner/ Lessee/Agent N r Signature of Contractor/License Holder I �� STATE OF FLORIDA � LL STATE OF FLORIDA.a LL COUNTY OF • ; r COUNTY OF xo� � The forgoing instrument was acknowledged befor The forgoing instrument was acknowledged befor mrn� �' rw this day of/hAAf.h 20/,iby�X� thisJday ofi%i/►1�% 204byW$ e s e o (Name of person acknowledging) -_� �� (Name of person acknowledging) (Signature of Vary Public -State of FloCida V (Signature of N t,ry Public -State of Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced Commission No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Kev.7/2ula