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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: RECEIVED JUL 0 6 2015 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: P.7 R,9 PINS 1 @J INPRt+?UEMENT LOCATIQ Address: Legal Description: Property Tax ID#: �`�D 'L L l° —0190 ^DD D Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DE-�SCRIIPTION QF V1/ORK � } ce NSTaISI INFORMATItJN: Additional wor to be pertormed under this permit—check all that appy: _Mechanical _Gas Tank. Gas Piping —Shutters _Windows/Doors - - _Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: Esq. Ft. of First Floor: Cost of Construction: $ 27 S� . Utilities:; Sewer _Septic Building Height: OWNER/LE=�S�SEkE; CONTR OR: NameName Addr> �3 �gu; �qf .- Company City:.;". State: Ic, Address:* �Z`l� Zip Code: )15 ot, s Fax: City: Stater Phone No. Zip Code: ��}LL�--� Fax: AA— E-Mail: Phone No Zai• o''�nlS�• ?ZZ t Fill in fee simple Title Holder on next page(if different E-Mail �A_ Cil from the Owner listed above) State or County License If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SaUPPL�ME1FIRY CONSTR+LICTI'©N LIEN TUU III 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 recording our Notice of Commencement. Sig t e6 Owner/Lessee/Agent Si ontractor/License Holder STATE OF FLOJIIDA LORIDA COUNTY OF �- 1,Vc 1 R COUNTY OF S-� The forgoing instrument was acknowledge before me The forgoing instrument was acknowledged before me this �v day of CsV 1:f by this 4:i day of ::yo -ky 205 by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Pub' -State of Florida) (Signature of Notary Pu 'c-State of Florida) Personally Known OR Produced Identi ' Personally Known OR Produced Identif Type of Identification �yNP, p\o�\da Type of Identification H' NNp GIVE pEA State of Ogg DEA o�florida Produced �1- fl L < PobV%G• Dec 16.2 Produced L, 0 public-state 16.2016 ,�. ,PGB Nota Y ExP\res B761 PP B, , o Y ices Der, ,� •: MY mm ss\o #EE B olatY Assn ° �c.=MY 0 mm.ExP VE 6g8761 Commission No. _° _ o n a\�ona\N commission No.��$ �o�. _ g �ion Assn. t ugh N •�- D d o NaC�Onll `��c dedZh o t. Nq` °c°r nded Z ro 9h ba �s REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 712014