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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO-BE ACCEPTED Date: $��1 Permit Number: LSM_0'3u 1 . - RECEIV�0 AUG 2 41015 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'RUP®SEDR,/U�1lEMENT LOCAl"tCDRI: Address: 18 4-D (" �i �t-L�g �n �� P -C--L- Legal L- Legal Description: Property Tax ID#: Z,31 ''l 2-Z Ono 2- Lot No. Site Plan Name: Block No. Project Name: DI &u) Setbacks Front Back: Right Side: Left Side: . DEAJLED DE�SGRIPTI®N Q-F WOaRK: tar o�� ��cg°��°�'� Sy Zir C® STR�,UCTId'N 1N�F©R+l\/(pAl'ION: Additional work to be performed under this permit-check all that apply: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric _Plumbing _Sprinklers _Generator Roof Total Sq. Ft of Construction: �i Sq. Ft.of First Floor: �li Cost of Construction: $ „r l� 2� Utilities: _Sewer _Septic Building Height: ®UVNER/LESSEE: s GONTRACT®R: Namel .,10 b C,,. >JAI�i Nater e: 1 Address- 1� x 5 C) `� CompanyJ; r�/J City:F�- 71 Cs?; ; Stater Add�es '' "" /9 t` Zip Code.-�3 _ Fax: City:- Stater Phone No. 7_- 7 Of, Cc 6- Cbd "'.`�l`��."7 ,�r.: _. FAX: E-Mail: Phone No !77� Z -70,Y "X13Fill in fee simple Title Holder on next page (if different E-Mail ,�oa� G6 Lw 0 W 6— from the Owner listed above) State or County Licens'CG & Y,3z-- If value of coristruction is 2500 or more,a RECORDED Notice of Commencement is required. SU RLEMENTAL C®NSTRUTION fEN La4W l FORMATION: 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 thepermit 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 commencina work or recording our Notice of Commencement. Signatuof Owner/Lessee/Ag(f t S' ature of Contractor/License Holder"�, STATE F FLORIDAcI STATE OF FLORIDA COUNTY OF -.LvCIe, COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me thisJ7 day of 2015 by this l-)—day of 20),�_ by (Name of person acknowledging) me of person acknowledging) _TA AAAJI" 'P�A_AtJ_ (Sign re o otary P767State State of Florida LOQnakure of Notary Public-St to of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification - Type of Identification Type of 1ntjficjjtion Produced Produced Oki Commission No. (SeAWFANY FORGET Commission No. :�_`• ���gl�ublic-State of Flori a . `�•: :•. .• My Comm.Expires Dec 20,2018 • Notary Public-State of Florida ="; oc Commission#FF 177249 9, P ���ii�� a roup a lona, o ar s n. Commis ion#'FF 129988 y REVIEWS FRO PLANS VEGETATION' SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 7/2014