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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: ��i�/�/J� Permit Number: RECEIVE® Building Permit Application SEP 21 2015 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: FCNA e w: d. +. �F. sr -,Will :i. Address: © �J� 'Qeoan Legal Description: Property Tax ID#: /1� 341 100 Z QQQ Lot No.33.s Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: 9 7-0N /71ec S' Q;r /MINI 'a^%^ N qtr: CQ "1`R1GT1 INS®R" NQ rr �+���= � `r�3' �wu, ��� .x � vii. � `� .a„�i9”Lr�-.�.k�r� n�, •�� r ; �. ita work to a performed un er t is permit-c ec a tat appy: Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors Electric, _Plumbing _Sprinklers _.Generator _Roof Total Sq. Ft of Construction: Sq.'Ft.'ot Fi"rst Floor: Cost of Construction:$ U O Utilities: _Sewer _Septic Building Height: ., N ' a w7i iiw' IER L�ESSE. r.i, ,. . Name , Name: cwo S Address: Jam- ��^'� �� 3� Company: S rG City: State: Addre s: f� S'ti✓ /P4 Zip Code: Fax: City: or�S�1.crC�� State:e�_ Phone No. Q`�f� `��' � 7 Zip Code: Fax: E-Mail: Phone No Y7?2- )}� Fill in fee simple Title Holder on next page (if different E-Mail WIAL from the Owner listed above) State or County License CJ If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SSU} •;I. IVtNA�CNS ���17 E( INR�IUTATI P,r g ' 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 gra nting-a-permit:wilI-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-arid.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/License Holder ::...4,. STATE OF FLORID STATE OF FLORID ' • ; = COUNTY OF COUNTY OF a m-< The forgoing instrum t was acknowledged be ri egg' The forgoing instru ent was acknowledged befo $40 D. this day of 20/rb z m�9 this day of 20�y � my 9-C.N� d c� �0= vw�x _ � zc c'Zc 2Q jqA/ (N me of person acknowledging) (Naline of person acknowledging) W N � N � ( gnature of N ry Public-State of Flori 61 (Signature of NPublic-State of Floficla) Personally own OR Produced Identification Personally wn OR Produced Identification Type of I ent fi tion Type of Identif1 ti n Produced Produced Commissi No. (Seal) Commission, (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED__ ev.7/2014