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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: �� 1 ` \S Permit Number: 156`� -(3 1 1 5 RECF!1: -D SEP 0 4 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 Commercial Residential X PERMIT APPLICATION FOR: C5 P?QM:r PROPOSED INPRyOUEMENT LOCAI'10';N e�. Address: 6TH A LAW-LA "'D . UD. Legal Description: Property Tax ID#: \ O I 1 I 0"3l S - Lot No', 'Z Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK R47"" 0 M ,,,j.^ K Additional work to be performed un<er this permit-cec 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: $ o9LI©d;,xx Utilities: —Sewer _Septic Building Height: OWNERjLES5E CONTRACTOyR .,z Name H + Aq.Wjul MDO-N Name: 0 Address- ('4b i vCompany: 9 City: C State: Addre -I� � Zip Code: 3H S I Fax: City: _,,,"C. State:, Phone Noa 9695t2i— Zip Code: Fax: E-Mail: Phone No''11`�.���� Fill in fee simple Title Holder on next page (if different E-Mail from the Owner listed above) State or County License If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. r SUPPLEIVIENTAL CONSTRUCTION LIEN LAIN INF QRMATION �, ,.� 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/Lice6se Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of 20_ by this day of ,20_ by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced 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 ev.772014 �r s 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 cQmpiencing work or recgrding your Notice of Commencement. JL, ignature of Owner/Lessee/Agent eignatureof Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF S L`Uc 0 g COUNTY OF !Sk. 4 y o The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of S P ,20 by this�day of S�?A ,20� by �Q 'e" wS (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Pu lic-State of Florida) (Signature of Notary PuAblic-State of,Florida) Personally Known J OR Produc Ab Personally Kngwn t i ao da Type of Identification" �b��c sspec—� � �roclucecl ype of Identificati pUbll6 Slate is 2p16 Produced ,,;111,,,. o�aty Q ..EXV``e .E�a58 p �4yAtY PUe��c��, Notarymm- ExP!rea De 66876 oPi` '. MyC 0� # °\atYCQmmiSsion_#o 31Not0ty Assn. Commission No.� rt �: (�e�kkro°�� Commission No �SonaedSht REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE. MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 7/2014