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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: �� �G" Permit Number: 56� �31Jr :I. v.. ,_ RECEIVED AUG 2 51015 ■ 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: STric�U w� k — W Y L PR®POS�E® IN?�ROVEM§ENT LOCATI'{�'N.: Address:_ �� i•J 11-f 19- E 67-,ni ZC� Legal Description: Property Tax lD#: `� a 5 v d 1~ ��1 r 6 'L�- y Lot No. Site Plan Name: Block No. Project Name: T05 �fr`�LE Setbacks Front Back: Right Side: Left Side: w h n 1)ETA', ESCRIFT.I®NOF 1/U®R+K: a M _,_m OW- 1we 6� Z- N-E lf J- S �c c v oAI &7h 01 fCrSTCT ON I:NFF®aR=i�/fAT�ION ., � Y T� . Additional work to be performed 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: Sq. Ft. of First Floor: Cost of Construction: $ �h00 0 L? Utilities: —Sewer —Septic Building Height: 011!/N:ER%LESSEEyf C®NT ATO'R R Name T65,6: j� L_�t &�Name: Sorr Address: 973 Company: �U[. City: (, �,/�i�it/v4T State:9W Address: /da Sr G����G-I•'� ��G Zip Code: Fax: City: l6c, 10(zV_CState:�L Phone No. S ='>(oSf Zip Code: Fax: E-Mail: Phone No m 3a Fill in fee simple Title Holder on next page if different E-Mail (—'Z4D,L �v2So.ti1 from the Owner listed above) State or County License Z?o ) 7 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CNSTR#UTI©N LIEN LAW I�IUiFORMA IQN: 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. Signature of Owner/Lessee/Agent Signature of Contractor/License Holder STATE OF FLORIDA I STATE OF FLORIDA COUNTY OF k COUNTY OF QJc'� e The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me thisa5 day of 20 �5 by this-. day of q-),q 20�5 by 'Li ViZ> ocsda\ fl � �sdh (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary' blit-State of Florida-,) (Signature of Notary Pu c-State of Florida ) VENS Personally Known �A'R'�oduced I iWic t Florida !, Personally Known ,,,,,,OR Prod uqEdltdaralf 6tion `1,1µY P("" Notary-pubic � b ,P s��.. Type of Identification ,r°� ;o: _ Notary Public State of Florida . . My Comm.Expires Dec 16,2016 Type of Identifica o 0 Produced �. :.' _ o _ EE 858761 Produced - `�;•c M Comm.Expires Dec 16,2016 mmission# notary Ass,�(' ?sW_11-11at commission # EE 858761 Bonde Zbrougb WWII,N :;:.Commission No. S ,"�p� eal> ._,. Commission No.. c°1 ThroughN,�a) . �., . REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.