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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 'I -;L a , 5 Permit Number: ISS H-Q 35 RECEIV _D- APR'2 21015 _ ---- - 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: PREPOSED INPROV IMtMNT L@CATIO"N: Address: /,0&U Legal Description: 79�� Property Tax ID#: y 5 1 1 " 1% 1 O - moo a_1 -G66 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: m7 77 DETAhLED DESCRIPTION OF WORK: XML CONSTRUCTION INI=ORiUTATION: Additional work to Be p&Formed under this permit-check all that appy: _Mechanical Gas Tank Gas Piping _Shutters —Windows/Doors XElectric _Plumbing _Sprinklers Generator _Roof Total Sq. Ft of Construction:. Sq.,Ft. First Floor: Cost of Construction:$ Utilities:4°' Sewe�i° �Septic Building Height: ©UVN�ER�LE=�SSEE: CONTRACT® Name �L � g Name:' % Add�;e'ss: / �, '°� L'�� mid Company: " �C� City: ;' n�:�� - State:� Address: 1 Zip Coder .` �2x: q City: 1/• �. "n{ State: Phone No. � j� J`" - �4-V Zip Code: y���\\ a:Fax: E-Mail: Phone No Fill infee simple Title Holder on next page (if different E-Mail from the Owner listed above) State or County License 9?-c /3 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SIJRPtEMENTAL CONST�a1�TIQN LIEN LAW INFORM�11"I®'N: 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: OWNER/ CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated. 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 rR_cording Vour Notice of Commencement. Signat e n s e/Agent Signa ure o'QZnr ctor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF '5 Ir . Ly r-'% COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this! ' day of q,60 20 5 by this A�day of , 20 (5 by (Name of pe on acknowledging) (Name acknowledging) (Signature of Notary blic-State of Florida ) (Signature of Notary blic-State of Florida) Personally Known OR Produc ia�4�b°r��6 20 Personally Known OR Produced Identification Type of Identification Q°b��6Q\tgs��g5 p Jype of Identification Produced L ••.,y oat°`0.ss`0� °a��'� Produced t �P L— .•Pr NNp IVENs . .: p(Florida Commission No. —$ � ;� 2`'-@alb` `' 'Commission iso. ^ Y� tatYPobltc( °16,20t6 85B70 �REVIEWS FRONT ZONING , SUPERVISOR PLANS VEGEt'1:0P1;:•' E MANGROVCOUNTER REVIEW REVIEW REVIEW REVREVIEW REVIEW' DATE RECEIVED DATE COMPLETED ev. 7/2014