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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONJ ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: J�.a• kr SCANNED Permit Number:BY St. Luce County RECEIVE®! Building Permit Application MAY 2 2 2015 Planning and Development Services 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: To Select from dropbox, click arrow at the end of line III I PROPOSED IMPROVEMENTLOCATION III Legal Description: t z_ ,/ Property Tax ID #: © D — a oo •- 9 Lot No. Site Plan Name: Block No. Project Name:fii�,+ �1 Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION -OF WORK: 111 INFORMATION: UHVAC L_J Gas Tank UGas Piping Oectric 0 Plumbing []Sprint Total Sq. Ft of Construction: Cost of Construction: $�'SO O !� Shutters ❑ Windows/Doors Generator 0 Roof S Ft. of First Floor: _ Utilities:Sewer FSeptic Building Height: / OWNER/ LSSEE: CONTRA OR: Name Name Address: g, Company;41 41iG - City: State.0 Zip Code: 9Jr%� Fax: Phone No. % �Z Z - V-o / - Addrersls:: 3/� z Jr - City:�LY G10e_e_ Zip Code.6' ( T !!� l Fax: Phone I 7/ State: - .2 /-6,� E-Mail: Fill in fee simple Title Holder on next page (If different from the Owner listed above) E-MaiI:S/r9 if S ,A ��1�L/ SN a7 ff , 11 E % State or County License:4 ' 5t C % ad d &5 `J it value or conscrucnon is>couu or more, a KtcoKuhu Notice of commencement is required. W SUPPLEMENTA ONSTRUCTION LIEN LAW'INFORMATION. DESIGNER NGINEER: Name: _ Not Applicable er MORTGAGE COMPANY: Name: _ Not Applicable Address: O Address: City: e-'r— Zip: 015,2, Phone: Stagy te:-7ff— —y5i — — / City: Zip: Phone: State: _ FEE SIMPLE TITLEHOLDER: Name: _ Not Applicable BONDING COMPANY: Name: _Not Applicable Address: Address: City: City: Zip: Phone: Zip: Phone: I certify that no work or installation has commenced prior to the issuance of a permit. no the ermit holder to build the subject structure r anScovenants that may restrict or prohibit such aed 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 recording vour Notice of Commencement. — Sig Lure of Owner/ Lessee/Agent jjj��V Signature r Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA cA COUNTY OF � - r,R_ COUNTYOF .2A , r� n The f oin g instryyye�e��_�nt was acknowledged efore me thisdayof 1, 20 by ). 40t.,,,_Ip OR Produced Identification of Identification Commission o4"k Nota Public State �lla Trade L Lamb My Commission EE 159114 Revised The forgoing instrument was acknowledged efore me this day of 20 by I17-01v-e112-:1 � (Name o � rson acknowledging) ) (Signature of Notary Public- State of Florida ) sonall n OR Produced Identification Type o Identification Produced Commission EE 159114 .r REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW RE IEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE (5 INITIALS C:T