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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date.+ � � _v2c�(� Permit Number: 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: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION: Address: �J d� i-u F Legal Description: SO tv L5a:» (iq 2-0aNS 5\< k�_k Lti ab I\aO agU'3VA�,1 On- ' Di� 1 Property Tax ID#:42go5 -4o -p"6 " Cx-- '-!c Lot No. 15b©3 Site Plan Name: Block No. IL+ Project Name: " Irl�Pj Setbacks Front "` Back: — Right Side: - Left Side: - DETAILED DESCRIPTION OF WORK: S (L CONSTRUCTION INFORMATION: Additional workto e e orme under this permit-c ec a appy: HVAC F]Gas Tank F]Gas Piping _Shutters Windows/Doors Electric 0 Plumbing Sprinklers F Generator F]Roof Total Sq.Ft of Construction: SFt.of First Floor: Cost of Construction:$ 3C�-! Utilities: _Sewer F]Septic Building Height: "OWNER/LESSEE: CONTRACTOR: Name- Name: i,COV�- L RL Address: b CEJ �1 i� �C'C �-- Company _ � 1O - S .71 City: C.t�Z 1 N 11 State: ° Address: a 'JL Zip Codc 1 X 10 -Lx>3`44 Fax: City: Stater Phone No. 40 -3LG+" 3�3 Zip Code: '_AQ� Fax: E-Mail: Phone No. (;)-519-Ct 108 0 Fill in fee simple Title Holder on next page(if different E-Mail:fn W ALD 5:0 IO f)K\ols CbNkll O �"� from the Owner listed above) State or County License:G GC 11 1 l cl\o If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:. DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable Name: LC- QQ ClciV Name: Ph Address:tocv � 4v a� Address: City: �o �� State:F1. City: State: Zip: 3 �� Ph e: - d - �( � Zip: Phone: FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable Name: uta Name: 1J1 uN Address Address:' City: City: Zip: Phone: Zip: Phone: 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:Y ur failure to Record a Notice of CommenceWmasult- your paying twice for improvements toy roperty.A Notice of Commencement must posted on the jobsite before the first' ection. If tend to obtain financing, consuln attorney before commencin rk or recQT0-ng yo4Notice of Commencement. s na a of Own /Lesse ure of or Lice older TATE OF F IDA ( 9 [!SS, ATE OF F COUNLA_C- e, COU OF L c The for ing instrument vyas acknowledged before me The forgoing instrument was acknowledged before me this 'dayof 2efl-1 el,4, 20 15 by this I day of �o v✓20 ( by CC�e,� �aa c�U rnu; ate( a-�1�;`r��. (Name of person acknowledging) (Name of person acknowledging) �3 av",C, O�. GCS -- fl (Signature of Notary Public-State of Florida) ``aR W. PCNA L, ��yyature of Notary Public-State of Florida) \-��5Q0�..... ..�C4i� / P��N111111111q//��/ Personally Known 1/OR Produced Identificat n :�o�M\ryI0 k*3pn y Known ✓ OR Produced lder � Ips�C� ��ii� Type of Identification Produced = 'sem W!Rpf 4entification Produced ��:ass,°> it �' C r O J� 79 S • We * Commission No.FF 1q5,33 (Seal) :„ #FF 195 om $bn No. f �533� Se ��io;99y?�pn6�C� N;�`\'�c�o�� �•� AFF X95� ;�o Revised 07/15/2014 Y11�f f p I;;ii0<� '�i��°Tg9yP UIB1!!G1t4;1!`� REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS