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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: �- 1� Permit Number: S a$-""Z C�1 �qy RECEIVED AUG 2 8 2015 p, R ._&_� Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: ce— PROPOSE'1NPR0 EMENT LOCATION K Y 7 Q I _ _ _ . Address: l d Z fhone_Wrrt� O f Legal Description: Property Tax ID#: �� —�G��© 0r�,- o 0 "( Lot No. Site Plan Name: Block Nol(.J4( Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED'DESGR(PTION OF 1NORK "} _ p ry 9a F� y0�' e c�rJo d ✓tom C.-2 CgNSTRUC£TION INFORMATIQN Additional work-to be�pertormed under tis permit-check all that appy: _Mechanical Gas Tank _Gas Piping Shutters. _Windows/Doors Electric _Plumbing _Sprinklers _Generator.::.; _Roof Total.Sq. Ft of Construction: a� Sq: Ft. of First'Floor: Cost of Construction:$ / ®� Utilities: Sewer. Septic Building Height: OWN ER/LESSEE.,_.. „ a CONTRACTOR �. Name DIt- 7c A 'f 60M Name: D&n i&I 7iQG Address: 7/7s -CJ e— Dr Company: -� 4 City: — State: Address: 1J i < I-i-if -c'✓�ts:'� �- Zip Code: 3007?(9 Fax: City: 1/ 5-L State: �L Phone No._63I- 1917 Zip Code: 3A 95,3 Fax: E-Mail: Phone No. 6-3 C)-26c0S Fill in fee simple Title Holder on next page (if different E-Mail: 0c, 2/'/soul Olt. o e=�- from the Owner listed above) State or County License: e CG 02q G,6 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. 1 SUP.:PLEMENTA .CQNSTRI#CTION LIEN LAW INFORMATIQN 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 commencjxLgwork or recording our Notice of Commencement. Signature of O n r/Agent/Lessee Signature of on ctor/License Holder STATE OF,FL ID ` STATE OF LO IDA ` COUNTY COUNTY111GL C.C�1 The forgoing instrum nt was ack wledged before me The forgoing instrument was a pknowledged before me this day of 201�by this�' day of L 20 6 by n Id � ©zA � CRY CLAUDETTE D.PAY l F'�,( Q l �� N�UDETrE D.PAYE (Name of person acknowledging)_ PUBLIC (Name of person acknowledging) _STATE OFFLORIDA STATE OF FLORIDA Comm#FF194477 �} Comm#FF194477 Expires 1/31/2018 Gtet� Expires 1/31/2019 412`/", � (Signat a of Notary Public-State lori a) (Sign ure of Notary Public-State of ida ) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Produced Type of Identification Produced Commission No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.7/2014