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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: / _ � �S� Permit Number: (� ' -7, VIVO- RECENVED Building Permit Application Planning and Development Services DEC 2 9 2015 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: PROPOSED N ROUEMENI' L CAi'I A, Address: V .5 Legal Description: Property Tax ID#: / X -?l 70/02-.-/f>d242 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DET�AILE© DE�SCR1P1"IQN QF UVORiK: dia -1;-q,- C0 STRUCTYONI INNR, IMA ATION: Additional work to be performed under t is permit-check a .t at 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:$ •ep� Utilities: —Sewer _Septic Building Height: OW ER/LES-SEE: CO'N,TRACTOR,: Name. � 'I f/��hk �jQj/ Name: Address: 615-1- S'* Company: Gr City: State: Address: Address: Zip Code: :5 a!4 6 Fax: City: State: Phone No. 2 7oZ Tv 7 - /4-3 S Zip Code: Fax: E-Mail: ['/lDv, $ 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. S"ll�P'PLEMEN AL CONS1"R�UCTION LIEN L.AW I'N`�ORMAI'10�1: DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _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 commencing work or recording our Notice of Commencement. c SJgnaturemfe,Ow Ar/Lessee/Agen o{/�....' Signature of Contractor/License Holder STATE OF FLORI °f` STATE OF FLORIDA COUNTY OF COUNTY OF T�o 0 The Wing instr ent was acknowledged before g mS R The forgoing instrument was acknowledged before me this day of 20��y z-y., this day of 20_ by � Wo= z m VVQ k1 118 1 C? 9 A ame of person acknowledging YIt (Name of person acknowledging) ignature of Nyary Public-State of FI grid a) (Signature of Notary Public-State oIf Florida) Personal) n OR Produced Identification/ Personally Known OR Produced Identification Type of I entific . Type of Identification Produced io Produced Commission N (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.7/2014