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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: j1-11- IS SCANNED Permit Number: AS-12•00 / BY gs_ ° St. Lucie County RECEIVED Building Permit Application Planning and Development Services DEC / 1 2015 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 PROPOSED IMPROVEMENT LOCATION: III Address: Legal Des Property Tax ID #: 312) - 3z I - O00 I - 000 - 1 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: III hsw_�_ CONSTRUCTION INFORMATION: I I Additional work to e e orme under tispermi -checka apply: E1HVAC Gas Tank Gas Piping _ Shutters ❑ Windows/Doors Electric 0 Plumbing ❑Sprinklers El Generator � Roof Total Sq. Ft of Construction: U aD Cost of Construction: $ �_ w_:M I 06 — S Ft. of First Floor: _ Utilities: Sewer Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name a • *"e. Name: _C,raj Company: Addres : V p� fh%�. City: State: Zip Code: Wig Fax: Phone No.A ] R • S SO ) - �k�© Address: a City: (' W11fr:Yt) r Zip Code: 1`69 I14 �` Phone No. 2k<� - C)Qq-4Dz� Stater Fax: Z)5 - T1• Q b2� E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mail: N 'AMDkJG � State or County License: C Z g it vawe or construction is SZ5UU or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNEM/—ENGINEERF Not Applicable Name: MORTGAGE COMPANY: Name: I Not Applicable Address: Address: City: State: Zip: Phone: City: Zip: Phone: State: FEE SIMPLE TITLE HOLDER: Not Applicable Name: 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 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 recording vour Notice of Commencement_ /2 --% STATE OFA STATE OF COUNTY OFCOUNTY OF The forgoing instrume t was acknowledged before me this 4l— day of N JBM 20 ,25:by Personally Known _ 4.OR Predoeed-Ide%&Wm ion Type of Identification Produced Commission No. Revised 07/15/2014 The forgoing instrument was acknowledged before me this 11 day of nZ()!/ , 20 LYby CrAAQ 2a ny.% IJ (Name of persdh acknowledging) (Signal otary Public- tate of Reift Personally Known' OR Piv n Type of Identification Produced M Pubfc REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS