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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date:\ ` 5 Permit Number: 5 III a51 �_ `',D NOV 16 2015 �_R_, . T RECEI , - 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: S� PRC+} C�}SED INPROUEMENT LC•}CATt(+�N: } Address: Legal Description: Property Tax ID#: L'19 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DMCRIPTI©"N QF WORK• O'c -S5:� C® 15TR++UCT10' INFORM+Al'4t4 Additional work to be pertormed 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: $ CD(z) Utilities: —Sewer —Septic Building Height: OWNER/ EE: C®NTRACTOR: Namel. IIID Na Address: ll LA I't ox, '�q+ Company: City: State:IL_ Address: Zip Code: elo�4GI Fax: City: State: Phone No. '�`?'L 373 G, 09D � Zip Code: E-Mail: r Phone No Fill in fee simple Title Holde on next page\(if different E-Mail from the Owner listed above) State or County License teluof construction is 2500 or more,a RECORDED Notice of Commencement is required. SU'P`PLEMENT �CONSTR'U ION LIEN LAW 1N �ORMpT10 DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable -.Name: e: Address: 7Address:City: State: y: State: Zip: Phone Zip: Phone. FEE SIMPLE TITLE HO _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 mencing work or recording our Notice of Commencement. Signature r essee Agent Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF 5�• �—yc�� COUNTY OF The forgoing instruq�ent was acknowledged before me The forgoing instrument was acknowledged before me this�� day of QO\) 2015 by this day of 20_ by RC'\ C \ d" SNV `MbdV5 (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Publi tate of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identifica:i Personally Known OR Produced Identification Type of Producelddenti cion ` EPNNF S ate o� Produced Identification 2� N°�a�y 'rtes�e 858781 Commission No. -i * d MY °��� °#EE °�aty psv-. Commission No. (Seal) u REVIEWS FRO T ..v-MM-1—N G SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED -�ev--.7/2014