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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE ONFO MUST BE COMPLETED FOR APPLICATIOH TO BE ACCEPTED Date: \a Permit Number: RECEI�,''�D DEC 0 8 2015 WHOM Pemoot App0ocata(on Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34962 / Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, cHck arrow at the end of line L PROPOSED IMP.ROVEMEiNT LOCAT,ION'6. Address: l J-- s�r� v e Legal Description: Property Tax ID#:,g L L( — (a0 — ©C�l d— C5C)C7 ? Lot No. Site Plan name: Block No. Project Blame: Setbacks Front Back: Right Side: Left Side: DEl'AILED D,ESC_RIPlION.-OF:4WORK. COUSTRUCTIOV I FORMATION - Additional work toe performed under this permit—check a appy: HVAC 11 Gas Tank ®Gas Piping _Shutters O Windows/Doors ®Electric ®Plumbing Sprinklers ®Generator ®Roof Total Sq.Ft of Construction: SQ.Ft.of First Floor: Cost of Construction:$ �(��? Utilities:[]Sewer®Septic Building Height: 01N11IERLESSEE CO,ITRACTOR: hlam Cs, �..� -�� Name: Cli n r1 Address: Ave -- Company: 15 11 :r- L City: -ec c State:�� Address:�7� a)�_ J� Zip Code:3 Y ci tS Fax: City: e rr e State:.�� Phone No. 7`7 d - q Zip Code: 'S-.)- Fax: //, `7 E-Mail: Phone No. I-lb � Fill in fee simple Title Holder on neA page(if different E-Mail:Wo N-` n CJ :t •�- from the owner Visted above) State or County License: C.4 C l % 36 R- / If value of construction is$2500 or more,a RECORDED Notice of(Commencement is required. SUPPLEMENTAL CONSTRUCTIONLIEN.LAIN INFORMATION: DE59G?JER/ENG0fflEER: _Not Applicable MORTGAGE COMPANY: —Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone: Zip: Phone: FEE SIMPLE TITLE MOLDER: _Not Applicable SONDING 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 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 work or recording our Notice of Commencement. s ign re of Owner/Lessee/Agent i ureof Contractor/License Holder STATE OF FLORIDAS L v C, STATE OF FLORIDA ,s�+ 1. COUNTY OF �-� COUNTY OF � The�rgoing instr meat was acknowledged�efore me The for oing instrument was acknowledged before me this day of e 20 Eby this day of Q ec ,20 1 by Lng�4 1 L A r 'J t% (Name of person acknowledging) (Name of pe son acknowledging) (Signature of Notary PubAc-State of Florida) (Signature of Notary Pu lic-State of Florida) Personal) Known OR Produced 1G��a�'o �\�2�,6 " Personal) Known OR Produced Identi i E\� \aa Type of Identification Produced 4 . S`a e� — . Type of Identification Produced t�5 � QJ� e �o o�aN Commissi �L��^PUb\\o ��es�eog5g�6� o• Commission No. � o�a� Ir.Qa�N, on NO. C1c�5Ca,,,1�,,, NoFxa #EE �a�vPss s oNa�� ON' r .m• ���`,, ':M`1 mss a��o oZZ goo Revised 07/15/2014 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS