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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / 2 Date: 10' IS I s-- SCABNNED Permit Number: =p6 e - 11 St. Lucie County RECEgVED immoommommommommommio Building Permit Application OCT 15 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 0< Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Address: Legal Description: Property Tax ID il: n ��� (�� (c (�© --- �� Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: Gsazc� fr �i %2 ✓Y0fl �� Jazr2� ,�-3C>4,.J��, , T 3z0�3V,44o03(9 /oPzop 3o8400 40? S,01 , //o. 2l 31C)_ Zr1C), a;17V/ -)I 9aI (�✓�Q �d c�lln,� VIIGI YYVIA IV UC HVAC CIIVI IIICU UIIUCI LIII3 F/CI I I IIL-I Oil MOPPly. Gas Tank E]GasPip ing _Shutters ❑Windows/Doors Electric 0 Plumbing Sprinklers 11 Generator 1:1 Roof Total Sq. Ft of Construction: S Ft. of First Floor: Cost of Construction: $�, �(7 Utilities: Sewer Septic Building Height: O�iN�NER�/,LTESSEE: CONTRACTOR: Name 7� So :Name: LL (= ���0Ar''A Address: ���%S ��77y �; % /r Company: 0�e_ LAc7nF City: �SG19 &C , Gl State: �—�o Zip Code: Fax: Phone No. 2 �- 2 Z Address: 2SCj 7'-- -4� Mpr✓� S City: State:�i✓ Zip Code: �!- 9 �— Fax: Phone No. 6 _ Z � , E-Mail: F> C®av/ � C 0 65� P 1/� /t% E-Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) State or County License: (5tc /.S Z 6)0,6 Z It value of construction is $Z500 or more, a RECORDED Notice of Commencement is required. Name: Address: City: State: Zip: Phone: E COMPANY: _ Not Applicable Name: • _ Address:' City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable I BONDING COMPANY: Name: _ Address: City: _ Zip: Phone: Name: _ Address: City:_ Zip: Phone: _Not Applicable 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 ano,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 recording vour Notice of Commencement. —Signature of Owner/'Lessee/Agent STATE OF FLORIDA COUNTY OF The forgoing instrument was acknowledged before me this _ day of 20 _by i (Name of person acknowledging) (Signature of Notary Public- State of Florida ) Personally Known OR Produced Identification Type of Identification Produced Commission No. (Seal) Revised 07/15/2014 s Signature of Contractor/License Holder STATE OF FLORIDA COUNTY OF The forgoing instrument was acknowledged before me this _ day of 20 _by (Name of person acknowledging) (Signature of Notary Public- State of Florida ) Personally Known OR Produced Identification Type of Identification Produced Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS SUPPLEMENTAL CONSTRUenON LIEN LAW IN MATION: Not Name: Addres City: Zip: -a FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: Address: City: Zip: Phone: MORTGAGE COMPANY: Name: _ Not Applicable Address: City: Zip: Phone: State: BONDING COMPANY: Name: _Not Applicable Address: City: Zip: Phone: I certify that no work or installation has commenced prior to the issuance of a permit. St. Lucie Counter 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 recording vour Notice of Commencement. _ STATE OFFL COUNTY OF The fqrrgoing instru nt as acknowledge this RY day of . 20 CtIC-AJWk.n) (Name of person acknowledging) yl �� (Signature of N ary Public- State of Florida) Personally Known od ceTeal) tio Type of Identifiication Produced Commission No. Revised 07/15/2014 STATE-OFFL COUNTY OF The forgoinginstru ent as acknowledl this Zrday of _( 20 h e "Fp U.r? 1 (Name of person acknowledging) (Signature of Personally Known OR'no tl c Identificfation Type of Identification Produced Commission No. (Seal) a REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE II 1!5 INITIALS