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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 9 /0- Permit Number: o�• U G RECEIVED _ SEP 10 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 PERMIT APPLICATION FOR: ROPOSED IN RUEM LOCATION: Address: a5.16 __ci ` ier' rL 15 Legal Description:/ c4 4 T„SUP �rLOZj� To -n5 PI Q� :E&reQ: L) i�� AJ If i r 92or mr(5 r c�� Lu Property Tax ID#:��L-10 S- 006- - l5sja ' Lot No.�� Site Plan Name: (7aUPjp Block No. Project Name: `l t ey) Setbacks Front_ Back: N/A Right Side: Left Side: DETAhLED DE�SCRIPTION O�F WORK; c i relic-Q, c C©NSTR+UCTION INFORMiATIQN: Additional wor to a performed' under this permit–checK a tat.app y: Mechanical Gas Tank _Gas PipingShutters _Windows/Doors — $ Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: Sq„Ft:of First Floor: Cost of Construction: $ o� c�GB� Utilities: Sewer, _Septic Building Height: .. O1N►NER/LE�S�SEE: CONTRAC�T®R: Na'me,, . LJ' ” Name: Address: ICompany: 6,0 Cmc Tn . City: �-� �e�r o_ State: , Address: &S o 56 )ihQ in4i a I P-M Lo, Zip Code: 0 Fax: City: pdL� SF (�P �� State: Phone No. 3: — Zip Code:9�2G Fax: E-Mail: Phone No -?") a • 3(6 -`J;JL(- Fill in fee simple Title Holder on next page (if different E-Mail rnww,a¢N, PQ �Y�C C} c _ from the Owner listed above) State or County License �R if value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENT L CC�?rNSTRUCTIDN LLEN LAW IpRMA7•IN: 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. Q'1' � ( Q(A ( .,/ Si ature of Own Lessee/ get Signature o o ra i rise Holder STATE OF FLORID STATE OF FLORID,p� COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The fof g,o'ing instrument was acknowledged before me this day of 20�Wby this 7 day of L° 20_&—by 02 (Name of person acknowledging) (Name of person acknowledging)(Signature of tary Public-State off lorida _� < (Signature of otary Public-State of FI ida) o �/ n Xn a Personally Known OR Produced Identific F&_ Personally Known OR Produced Identific idrrn"o Type of Identification m Type of Identification ���m Produced 8t< Produced � W Z = LN Commission No. (Seal) Commission No. (Seal) m Op �N REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.