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HomeMy WebLinkAboutBuilding Permit Application Dec 18 15 01:55p p.2 ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: � 3 Planning and Development Services Building Permit Application Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772}462-1553 Fax: (772)452-1578 COrl Mercia I ________. Residential >� PERMIT APPLICATION FOR: —~ To Select from dropbox, click arrow at the end of line xv A. �=orT� Pier-� � ►=c_ . Legal Description: 1cLr� ���2Y- E5-}�-�-e -5 4q S - � Property Tax ID#: 3 q0 - l0 10 Site Plan Name: Lot No, Project Name: Block No. Setbacks Front_`_ Back: .�_Right Side: Left Side: L+ :..Ts 'gc) A.. d- AUCHrional worto e e orme un Em is perm it-IRIc ec ap y' ap HVAC Gas Tank Gas Piping _Shutters (� Electric �{ Windows/Doors �l Plumbing Sprinklers a Generator Roof Total Sq. Ft of Construction: SFt.of First Floor: Cost of Construction.$ y�jQ� ,DO ((''�� Utilities: Sewer LJSeptic Building Height: Name C) tit ►"nprq a '`�.~ '�" '' ,. f + ` Address: -6C109 Q Name:�y to �rYJP 2 m o Dk� I V L City: V--t Company: State: (_ Address: 0� Zip Code: 2 � 'I S a, Fax: ' ---� S Liv(4 4 . Phone No.�654 — 9a 3_ �4 C� City. r State: �. E-Mail: `-- Zip Ccde- Fax:.-7-7 Q- 93 4_ -)Gil Fill in fee simple Title Holder on next Page f different Phone No, '7�.p7��/�-�g^j l �t�� P g i E-PJlail:�� z9`—'4 C �Q.�'1lCP c from the Owner listed above) State or County License: ( If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. P.3 Dec 18 15 01.55p .� +cam -0 3�, .� .. }�Ij�j u ` "..y �'9 x'nr SI h REM h '.'}cu ©ESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable Name: Name: 1 Address: Address: City: State: City: State: Zip: Phone: Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable i Name: Name: Address: Address: City: City: 1 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 commencin r recordi ur Notice of Commencement i i s _Signature of Owner/Lessee/Agent Signature of ontractor/License Halder STATE OF COUNTY OFORo A Lo_c_t-�2-� I COUNTY OF STATE OF {3RIDA~��� 4. � J I� MThe far ping instrument was acknowledged before me l' The forgoing instrument was acknowledged before me i this F day of 1!� e U_rv1 }�� l20 L<_by � this�dayof���rl1��,.2Q 6 ++ I I i (Name of person acknowledging) (Name of person acknowleaging} (S+&tature;dfNotary ,!r�ublio-Stake of Florida} ignature of Notary Public-State of Florida) eras;:ialty Known" 7+ JOR Produced Identification I Personally Known OR Produced Identification rype.of identification Prb.doced Type of identification Produced corziTnission IVa.-- r§dDA MAM�Ot1CHAfiDdC "? ?:.�9 HARD (Seal} _ ? MY CC.IMM1SS117N#FF125526 RAY COMMISSION#FF125526 Or -. arr�c�, S May 21. 201$ ea ay '•.,,Of M1•� OF F�, r ,- 398-6153 Florida*iatarYService.coR1 Revise 07/17/ a67, 6153 F+oriclallotaryService.com I REVIEWS FRONT I ZONING j SUPERVISOR i PLANS ( VEGETATION 1 SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW I REVIEW REVIEW DATE COMPLETE I ' INITIALS �_