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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: ro IS Permit Number: 1 d�'0304 RECEIVED SEP 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 Commercial Residential PERMIT APPLICATION FOR: < PROPOSED PROUEMENT LO lT Address: . Legal Description: Property Tax ID#: �G„� �(�O-�j O f (�0 0 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAIL.E® DESCRI'PTI'ON OF WORK. U ' CONSTRl1CTI,0.�N 1!N!F®RMATI®N: itiona work to ape orme under this permit-check 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: $ f� � Utilities: —Sewer —Septic Building Height: OJWiN, EER/LEaSSEE h CONTRACTOR: Name Name ;� L:r�,� Address: -&-x '7y'3 Company: ze City: State: G. Address: Aka [/ Zip Code: ,31 �s" Fax: City: �1 c�� „ y State:—LL Phone rNo. 7_1P Zip Code: W, m 2 Fax: _ 3- E-Mail: Phone No -7"2 - Fill in fee simple Title Holder on next page(if different E-Mail _5 P n ai-75 j` P Gd `'�a'yl�� • �%�'l, 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 CaNSTRUCTI©N IGEN LAW INFORMATION: 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 wor r recording our Notice of Commencement. �­Y � Signature of ner/Lessee/Agent Signature of Contractor License Holdef STATE OF FLORIDA P STATE OF FLORIDA �y COUNTY OF . LAA-" COUNTY OF The forgoing instru nt w cowledged before me The forgoing instru ent was cknowledge"efore me this ay of 20� by this_Lffday of 20_1�_°by 't[) M_ t/, cso10 � BVI. iso � I lh �� , Ih I" . (Name of person acknowledging) (Name of person acknowledging) IL (Sig V, re of Notary Public-State of Florida ) (Signatu of Notary Public-State of Florida) Personally Known OR Produced Identification ✓ Persona y Known t/ OR Produced Identification Type of Identification Type of Identification Produced UCProduced Notary Public State of Florida °fir°96� Notary Public State of Florida Commission No. 1' J: Judith M Vii Commission No. _ Judith M l il�g}� ✓�/ (���3 1 y Commission F 017314 My Commission F 017314 OF w Expires 07/14/2017 y�or � Expires 07/14/2017 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Te—v—. 7/2014