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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: `�' Permit Number- RECEIVED U - ,- RECEIVED Building'Permit Application JUN -2 2015 Planning and Development Services Bullding and Code Regulation D/vlslon 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 and of line Address: \ Lega Dese I tlon: 1 Property Tax ID#: ©l� Lot No. Site Plan Name- FL_ Block No. Project Name: . 1 Setbacks Front Back; Right Side; Left Side: Oda 4&r W/ itiona or o Orme undert s permit—cec a app y. VACM Gas Tank E]Gas Piping _shutters Windows/Doors Electric Q1 Plumbing�—' Sprinklers Generator 0 Roof Total Sq.Ft of Construction: �1 ( lam S . Ft.of First Floor: Cost of Construction:$ Utilities;llSewer Septic Building Height: Namei Name " Address; PL �'� Company: City: State' Address: I /� Zip Code:. T7. Fax: City: VC J(_.., ' 5tate:_� Phone No.' s t_( Zip Code: Z E-Mail: Phone No. Fill in fee simple Title Holder on next page(if different E-Mail; * from the Owner listed above) State or County License: If value of construction Is$2500 or more,a RECORDEb Notice of Commencement Is required. IL c00/L00I2 33IA83S*A8013V3*08VA0a8 Lc9LL9bZLZL XV3 Zc'.9L 4LOZ/LO/90 h' h DESIGNER/ENGINEER: Not Applicable . MORTGAGE COMPANY: T 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. 'WL'St.L�tcle County make no representation that is granting a permit will authorize the permit holder to build the Subject structure is in conflict wit 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.Lucle 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 of Commencement may result in your paying twice for imp ovements to your property, A Not' e,o ' "' m nce ent must be recorded and posted on the jobsite bef a the first inspection, If you nten - axf anti ,consult wit lender or an attorney before com enein w din r N t; - enc ent. Signal a of ee m 51g re a Co tra ce se Hold MIA .- The S+T�AT OF/�F Qe'.� SrT/�A E OF/��+t3RID `COU O 1 A V, T 41/U VC fo ing instr a a nowledged f M The fo Fing Instr t was acknowledged before me this�day of 20 I b w '' this2`"t'day of. iWu 20.—Ni:ty o c R m 2W ty uv� a�(:� (Name of pers n ac nowledgIn J (Nam f p r n acknowledging) Signature of otary Public-State of Florida) Signature of tart'Public-State of Florida) Personally Known .-r^'OR Produced Identification Personally Known Produced Identification Type of Identification Produced Type of Identification Produce�dG, Commission No.E asq,_ -2— (Seal) Commission No. ��+. (Seal) Revised 07/15/2014 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS 800/Z00l1 30IA83S*A8010h'3*O8VA089 L89LL9VZLLL Kd3 Z8:9L 9LOZ/LO/90