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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED L/l Date: o� / �� Permit Number. RECEIVED T ' AUG 2 17 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 CommercialResidential PERMIT APPLICATION FOR: g /0/- /V/9 ' r-� �c� a, PR © UME� �I c T LUCi4 1©N: Address: l ; a' Legal Description: 5" 63 oZ TW 5o y0 Property Tax ID#: 002����-233 O©©r,Z D C 'j1.3 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DFS�R+iPTI�N ®F WORK: CONSTRUCTION IN.1=01RMZT113 Add itio na.1 work to be pertormed under this permit-check all that app!y:. _Mechanical _Gas Tank —Gas Piping ':Shutters _Windows/Doors Electric _Plum ing Sp�iraklers _Generator _Roof Total s q Sq. Ft of Construction: O� S . Ft.of Firt Floor, q �1��, .. Cost of Construction:$ 0q b Utilities: —Sewer —Septic Building Height: ®,V1/N ER/LE�SS�E. CONTRA�T'OR: s Name 0 C'�!h 1e 7,r7G Name: ® �'��r a, Address: �8�A ✓� �' A. e Company: L6?-W'ate, a g 4 rl o LGe- City: &.&W da) State-V6 Address: 'J'W-g.;? L-onza',7 C:5> Zip Code: Cg,2 9-/ 9 Fax: City: A - r�/e�J�4'e Stater Phone No. 0YP7 .75-116 Zip Code: ( / ,/ Fax: 90' 7-2Z'_'-023'_Q E-Mail: Phone No �",C/6 7` Z/�" -76 -v ;?- Fill in fee simple Title Holder on next page(if different E-Mail/./a. /fib Pr(f'in ew /oS . C6dl1 from the Owner listed above) State or County License If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRI.l1CTl®N L'I'EN LAW I' �1=0R+iUTATI(�N: 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. Z- Signature of Owner Lesse/ gent Signature of - ntracto:r/LPcense Holder STATE OF FLORI - STATE OF FLO " COUNTY OF _ COUNTY OF xKa n& The forgoinginstr nt was acknowledg a fare a The forgoing instru nt was acknowledged be 4�T this day of 20 this day of 20 z s o mac 2 M9 =rnT2 02 r;d)rL (Name 6f person ac I dging) _ _ (Name of person acknowle ng) (Signature of Not r FKublic-State o tori ) / (Signature of Not Public-State o I oritla) Personally K . wn OR Produced Identification" Personally Known OR Produced Identification Type of Identifi i n Type of Id�rrt'f ion Produced Produced - G Commission N '. (Seal) Commissio o. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.