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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED G Date: \4116��5 Permit Number: 15 10 RECEI'."I OCT 16 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: To Select from dropbox, click arrow at the end of Iine Uc>r F'RQPQSED IMIM LQCATIOIU: 1 Address: 5700 St O or ))r A Legal Description: A/0- Property Tax ID#: / ® D/Z/ —O?O -- 2 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: D'E�`AfL�ED D"ECR�PTION ©�F Vt/�O�RK: Z 7LG�� l lGam-/c L C©NSTRUCTI'(+O:N INFO ATION: itrVIionawortoeperformed unertis permit—check all appy: VAC Gas Tank', E]Gas Piping _Shutters Windows/Doors Electric ❑ Plumbing Sprinklers Generator Roof Total Sq. Ft of Construction: S Ft.of First Floor: Cost of Construction:$. .?, 300 Oa Utilities:Sewer 11Septic Building Height: ON,1fNIER/LERSSE�: CONiITRrAC�T®R: Name ase du z Name: Toi-(re E (or Gtl/l�id!L'�n Address:✓ w C—:kd 15z Company: (�YCLV10.e��c��it i' City: /�IY4_1 State:/_C Address: 141 V�S LQ DaAw Civ Zip Code: Fax: City: eS/ Stater Phone No. Zip Code: 3 5(5S-R Fax: E-Mail: Phone No. Fill in fee simple Title Holder on next page(if different E-Mail: 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 C®NSl"R!Uk©N LIE°IV LAW ;IftZM�MAC®N. a o DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone: Zip: P one: FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable Name: Name: 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 cove ants that may restrict or prohibit such structure. Please consult with your Home Owners Association and review your deed for anV 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. ZA& s _Signature of Owner/Lessee/ ent Signature of Co c or/ icense Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF �fi. Luc\� COUNTY OF S'1'• V c\' The forgoing instrument was acknowleclgedbefore me The forgoing instrument as acknowledg d before me this day of d c �' 20 by this`4+ day of C`� 20 by 5:�- G c d,-4,A X f q0t 4L (Name of pe on acknowledging) (Name of p rson acknowledging) (Signature of Notary Pu c-State of Florida) (Signature of Notary Pu 'c-State of Flor�a� �-.�S �°<�aa r: Np G\VEP�` Personally Known OR Pro uc � c�>,o 0��° Personally Known s.,0 "ProdcP Id'e'r1if�cQtic3� Type of Identification Produced = illS�a�y�c�6 y Type of Identif'c r1 ?;ro, uce XI Sae 59161 1 '� • Q�b tiQ`�e ��9 ac',�,-sJ` C°�• Sto°� ,,�;;i,�as'1`-�,`.'�, Commission No. 5 � o�a�o��c(•Sealj \\o a����• Commission No. Q ,• `pus+,�, ��G ��cn� ��,te cr3 "`' /'` ,,, 90t\dedthi" � Revised 07/15/2 \ REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS