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HomeMy WebLinkAboutBuilding Permit Application ,PPLICABLE INFO MUST BE COMPLETED FOR APPLICATI0hrTO BE ACCEPTED Date: a/ Permit Number: REC.EIV�D SEF 212015 Building Permit Application Planning and Development Services RaNding end Code Regulation Division 2300 birginia Avenue,Fort Pierce FL 34982 Phone: (772)462-7.553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: Address: Jr/ a� � �C r 'A�L - — — Legal Description: Property Tax ID#: ��� — Lot No. Site Plan Name: Block No. Project Name. Setbacks Front Back: Right Side: _Left Side: A C" Arse o'[— t Qnal work o De performed under-this permit—chpck 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:$ 710 i" Utilities: —Sewer —Septic Building Height: Name - Name: L'urtts 'Sax rn©n_5 Address: /b . Company:_Cuog re?tt- R('r- City: ,9 g'_ `S'zr 'u - State: r' Address: t( 15 S G i r - zip Code: v Fax: _ City: 5T bix ie. State: L. Phone No.� zip Code �4 _ Fax:�� 1 E-Mail: _ Phone No. 7'7 -Ja32 Fill in fee simple Title Molder on next page(If different E-Mail; C Q from the owner listed above) State or County License: -A C 4 ' IN 10 If value of construction is 23e0'or more,a RECORDED Notice of Commencement is required. e DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable Name: Name: Address: Address: State- City: State: City: ------- Zip- Phone: ZIP: Phone:ne. FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable Name: Note: Address: Address: City- City: Zip: Phone: Zip: Phone. OWNER/CONTRACTOR AFFIDVff'Application is hereby made to obtain a permit to do the work and installation as indicated- 1 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 Pe Id the subject structure gurnit will authorize the permit holder to build 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 iri accordance with the approved plans,the Florida Building Codes and St,Lucie County Amendments. The following building permit applications are exempt from u'ndergoing 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 6 Notice of Co' mmencement 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 tender or an attorney before commencin work or recorftg your Notice of Commencement. Signature of Owner/_t�gent_/Aess I ee Signature of Contractor license Holder STATE OF FLORIDA STATE OF FLORIDA C I S-L OUNTY OF si� Lu I e, COUNTY OF The for no nstrumept was acknowledged before me e forgoing insum forgoing IThitrer rdwas acknowledged before me this_; day of 2Ol by this Z4_day 20-Zf, by (Name of person acknowledging) (Name of person acknowledging) _ Signature of Notary Public Stai:iVof Florida (SIgnAure of Notary Pubfl6_5ta Flohda) Personally Known V OR Produced identificatioii Personally Known OR Produced Identification Type of Identification Produced Type of Identification Produced !Xil CHFIWMk&-ENaU$jI ;7& YY COMMISSION EF 850284 )MyCOMMWH)N#.Eag,92,,Comm.ission No. R Commission No.4�� 41) #00' EXPIRI!$:Apfff4,2Q17 kXPlRFS;APrff 4 201 Omw Thm kool N6ri SW.W 80JJt REVIEWS FRONT ZONING. SUPERVISOR- PIANS VEGETATION SEA TURTLE lt4ANGROVE COUNTER REVIEW REVIEW- REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED -R-ev-7721314 Lo