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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: �?' 1j SCANNED Permit Number: 17�s BY ' St. Lucie Countv 22 2p15 Building Permit Application 0 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 t/ Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III Address: Legal Description: Property TaxlD# 5i9 — J~" —.10,9 Site Plan Name: r U Project Name: Setbacks Front Back: Right Side: DETAILED DESCRIPTIONCOF`WORK: LeftSide: Lot No. Block No. 4_ CONSTRUCTION INFORMATION: itiona war to Formedunder tispermit—Checka appy: ❑HVAC f] Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors g1flectric ❑ Plumbing ❑Sprinklers ❑ Generator ❑ Roof Total Sq. Ft of Construction: S . Ft. of First Floor: Cost of Construction: $ o`1.5J50 r.01) Utilities: Sewer ❑Septic Building Height: low Z �r OWNE LESSEE: CONTRA OR: Nam Name Address:. Compan • o City: Stnt .! Zip Code: Sa Fax: Phone No. iW 2'91--7 9, S� Address: 9 // f City:;otr, , e-JLe State- Zip Code#l/ Fax: Phone No. LIP© 7 E-Mail: .1 Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail:s/C,uS ?k';P&°'L,1S�917W State or County License: 43-0 09% A-0-2f �57 if value of construction is $2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION 'LIEN'LAW INFORMATION: DESIGN G,INE R• _ Name: Addre Not Applicable MORTGAGE COMPANY: Name: _ Not Applicable Address: City: Zip: Phone: /-S State: 1 a 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. St. Lucie Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure which is in conWict with any applicable Home Owners Association rules, bylaws or ana 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 _ Sig ure of Owner/ Lessee/Agent Signature of 0o ntractor/License Holder STATE OF FLORIDA c p STATE OF FLORIDA COUNTY OF J0k, . -1 r COUNTY c - The forgoing instryi�ent was acknowledged before me this day of Ma , . 20 �by (Na e f person acknowledging ) w (Sig ure of Notary Public- State of Florida ) _OR Produced Identification Produced Commission No.ujl Public state R t ,& Trade L Lamb Revised 07/15/2014 The far in instrument was acknowledged efore me this day of 20 by P sonally Know OR Produced Identification TVPE,ation Produced- No. L Lamb REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS C�