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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED a Date: 15 Permit Number: -- -- - RECEIVED JUL2 8 2015 Builing 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 PR©PQSED IMPROVEMENT LQCATIgN: Address: Legal Description: A 5/0 1-o%A C®, -161�) Property Tax ID 01169-5b3 oo-7 Lot No. Site Plan Name:' Block No. Project Name: Setbacks Front Back: Right Side: Left Side: �.ETA.�II�ED�D�E�SCR�1'PJTI;Q,COF ..pR�: L_i e- 4e-.?W C®NSTRUCTIONINFORMATION: Additional work toe e orme under tis permit—c ec a appy: HVAC E]Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors . ❑Electric ❑ Plu'm'bing Sprinklers Generator Roof Total Sq. Ft of Construction: S Ft.of First Floor: Cost of Construction:$ �J L ®0 Utilities:Sewer Septic Building Height: dRI LESSEE; CDNTRACT�OR• NameXN ame:kk6- ,1'j/t'F�Zg kk� f Address: �Z�'f� / " Company: City: �✓ ��® - State:_ Address``: d '72-5 '�.��1� y � Zip Code: 3 LM 91- Fax: City:ZT"5i�b uc l E State: Fe- Phone No. ���s�bD°7���� Zip Code: '3 5� Fax: E-Mail: Phone No. 2-- 3ZZ-5 1 V Fill in fee simple Title Holder on next page(if different E-Mail: C—Ir, �7 e—�r'eeZ4? 'Z_C'0 iJca, vim.ca from the Owner listed above) State or County License:GRAC d k17 2 yc/ 2 � If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. S(:1PF'LEM°ENTAL.C©NSTFt{�C`fl®N L( N;t.A11�/ INF0�2�MATIgN: 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 recording our Notice of Commencement. s s Signa ire of Owner/Lessee/Agent S' nat a of Contractor/License Holder E OF FLORIDA S TE OF FLORIDA COUNTY OF $-V, Lac.\ COUNTY OF The forgoing instrument was acknowledged before me Theforgoing instrument was acknowledged before me thisZL day of l-, 1\A 20 �by this f day of 20 by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary PubV-State of Florida) (Signature of Notary Public-State of Flor' P GiVENg pEpC1P1 laic of Fic)0 Personally Known OR Produ ed Identif' Personally Known ft Produc I 1tti is gt06, Type of Identification Produced ti iVEN 060 Type of Identificati P te, Pjes 56i SEP Siaie 2� ;z Commission No. �� �y($��i �ces�eC1 g16� Commission No. _�y 00m his u°na�NOiaty Pu Noia �i,P EE 95 Pssn. ::Pwv e(�c'•%�y�°mm; .\On# n i�0i2(y A�,-D .,;E,o�,,,. ` `• • � mss ai�o ai , Revised 07/15/201 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE :IN:lTIALS