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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONc' z ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: SCANNEL, BY St. Lucip C011rib Permit Number: I'51 / ' d315 Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 RECEIVED NOV 1' 9 2015 PERMITTING St. Lucie County, FL Commercial x Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III LOCATION: Legal PropertyTaxlD#: - F7 Lot No. H 13�121 Site Plan Name: ��� Block No. Project Name: T-WE ©P(tCe S r' V pj Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: III Install facade sign INFORMATION: 11HVAC E]Gas Tank Electric 0 Plumbing Total Sq. Ft of Construction: Cost of Construction: $ 1 c�l O, 0c) Piping IJ Shutters nklers E Generator S Ft. of First Floor: _ utilities :�Sewer Septic -- I Windows/Doors EI Roof Building Height: OWNER/LESSEE: CONTRACTOR: Name .J � S 1 L4C Name: LR V ( N S Address: . OS w W4 Company: City: OQ� s 1_v G� State: _ Zip Code: Fax: Phone No. — 3 O- 11-7 Address City: V S L_ State: ffi� Zip Code: 'ZL4 R5L— Fax: one No. 2-SS E-Mail: "\ t L , Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail: � State or County License: If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. F' c SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION - DESIGN ER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone: Zip: Phone: FEE SIMPLE TITLEHOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable Name: Name: 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 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 orrecording your Notice of Commencement. S _ Signature of Less t Sig6atun ense Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OFsrwde COUNTY OF• The f r oing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of 20 Eby this 19 day of W) 20 _by IL�OII' (Name of pers acknowl d ing) (Name of personAcknowl ing ) ign ture of Notary Public- ate of Florida) nature of Notary Public- to of Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identificatf Type of Identification Produced Type of Identification Produced >`pda vs?'SrA•0-lob •yS9 Commission No. _. r--. ,_ - Commission No. - ,,,,($gaU .;,_.�-,5 ,a..„ LASHAHNA INGRAM Notar Public . Stale of Florida ... LASHAHNAINGRAM ; U~�a. "�o�.,, WaryPublic -State of Florida • My Comm. Expires Dec . ; . My Comm. Expires Dec 20, 2018 Revised 07/15/2 or Commission # FF 177249 N ;K- Commission k FF 177249 '%: P,;:y�d° 8ondedthroughNalicnalNotaryAssn. o;•• '•' Bonded through National Notary Assn. REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS