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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE'COMPLETED FOR APPLICATION TO BE ACCEPTED Date: �`"�O•-�� Permit Number: '% NCO' da3a RECEIti'rD MAR 1120116 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 lineXto PR�POSEI3IMPROUEM�EN LOCATION; Address: 3 Legal Description: n Co.o p_(zr—cz�' S-\ Property Tax ID#: go 2 — 0 O( —00 O— cl� Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DEl' PLED DE�SC `f10`I� `Yec�.r- o��% SG,�c�c�le, r-�o..�- . �rs�-F�� n�ry 1 �7L ✓/��r-'��,,ti.e�.�� CONN TRUCTI©N .1,LN MATION: Additional work toe e orme under t —checkispermit a appy: HVAC Ei Gas Tank ❑Gas Piping _Shutters Windows/Doors Electric Plumbing Sprinklers FIGenerator _Roof Total Sq. Ft of Construction: I q 0 0 Sq. Ft.of First Floor: Cost of Construction:$ -2,0 -1-- Utilities: Sewer Septic Building Height: 10 I OWNERJLEASSEE: Cl7NTRA TOR; Name �__.tt Name: S_e..�15 Address: 5301 £,6b� fie— l� Company: Tclr_� �ooF City: �A— Zr-ce, State—P—t— Address: V2A 0 os\o Zip Code: S�kFax: City: U21'D State:-X5_L Phone No. Zip Code: Fax: E-Mail: Phone No. ���^lam gbyo Fill in fee simple Title Holder on next page(if different E-Mail: Cao L) (2ct t � � , Cat"\ from the Owner listed above) State or County License: If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. Sl1PPLEMENI`AL CONSTRUCTION LUEN LAW IN'f©"RMATf®N: DESIGNER/ENGINEER: of Applicable MORTGAGE COMPANY: (—Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone: Zip: Phone: FEE SIMPLE TITLE HOLDER: _L,,W6t Applicable BONDING COMPANY: L,4ot 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 thepermit 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 _Signature of Owner/Lessee/Agent Si�rta r eontr cense Ho STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTYOF mer The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this to day of 20 k�- by this]I Q day of d—CGS 20 I G by (Name of person acknowledging) (Name of person acknowledge g) �wz (Signa urge of Notary PA ic-State of Florida) (Signature of Notary PU`1Iiic-State of Florida) Personally Known OR /ro "45 ,� en i Icatro� ��EZ JPerso . Ily Known OfZ,Rr dyced IdentifiGA DPEREZ Type of Identification Produced o`'�s"vn�B�;% o Identification Pro .0a� ublic-State of Florida q (� Nyq My Comm.Expires May 1 ©qI n • My Comm.Expires Nlay 18,2018Commission No. o Ub�vCommission#FF 0 sion No. "' aq , OealE sion#FF 086006 OF f� � ,,OF F����,` Banded Through National N Bonded Through National Notary Assn. Revised 07/15/2014 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS