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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONaai ALL APPLICABLE INFO M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: SCANNED BY •A St. Lucie County 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 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line `'`PROPOSED IMPROVEMENT LOCATION: n Address: Z5.1 c Legal Description: Property Tax ID #: 3 d 7 b — ©b—_5 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION F WORK: 15 ZZ tV1kb 1 5 zN U51 N� X r t I M af-k CONSTRUCTION INFORMATION: itiona wor to e e orme under tispermit-c ec a appy: OHVAC Gas Tank ❑Gas Piping _ Shutters Windows/Doors ® Electric Plumbing Sprinklers E]Generator E] Roof Total Sq. Ft of Construction: S Ft. of First Floor: Cost of Construction: $ 13000 00 Utilities Sewer Septic Building Height: OWNER/ ESSEE: CONTRACTOR: Name -(LW ' KoSS Name: %11s;i,, c 1�a_ ttL Address:t3 0dQ DMV_ 0 tA Company: City: rl State: �' L Address: /5;' 7 S m l ofrA Zip Code• Fax: City: /'!� �% ,v, ,i. State: /�' t- c Phone No. �J - 5ol D - Zip Code: 3 31N Fax: 3U5' 2 3 3 ( S'L Z- E-Mail: Phone No. 7 .2Ig D-.2 �'a/ .3us 233E Fill in fee simple Title Holder on next page( if different E-Mail: from the Owner listed above) State or County License: 3 001,14( If value of construction is $2500 or more, a RECORDED Notice of commencement is requires. L SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone: Zip: Phone: FEE SIMPLE TITLE HOLDER: _ 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 or recordin your Notice of Commencement. of O er/ Agent/ Lessee Signature of Contractor/License Holder IF FLORIDA STATE OF FLORIDA OF_,5± I..U-CX e, COUNTY OF The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of � c: w,6dr+ , 20 14 by this day of 20_U by (Name of person acknowledging) (Name of person acknowledging. ) (Signature of Notary Public- State of Florida) (Signature of Notary Public- State of Florida ) Personally Known Personally Known Type of Identificati1 ,.,d VICTORU L TILLMAN Type of Identification odd •,,,_ DIANA L MATTHEWS :.L MY MMISSION I EE 10264 Notary Public • State of Florida EXPIRE�,29, 2015 M Co lres Se 19, 2014. Commission No. jYr �T 66GGcc Commission No. s• ` • y r[61ep p egde nru Nu Underndttis as �� Commission #E EE 27124 Revised 07/15/2014 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS