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HomeMy WebLinkAboutUntitled ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t t Date: -7 i Zo IV Permit Number: RECEP 16 Budding Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce Ft 34382 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Q�� q J " Address: S . ©c ea n a i,v-t Legal Description: IDc+nQ u.aaXY. t3N -R-0 OC roan 0,14/4 15itk.d A011ar 064(4 'U44 A vw4 122 oa- 30aq - !(e4F7� Property Tax ID#: 3 5 a`' - ©7' Obb + - p0 0 -7 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: (?.�.ptaae �ts�+►,,.� -e.��c.-�{•� wa.:l�v h�aR-�er . 50 g-.1 Additional work toorme under t is permit-check a appy: HVAC M Gas Tank Gas Piping _Shutters F]Windows/Doors OElectric F�Plumbing Sprinklers U Generator l]Roof Total Sq. Ft of Construction: S Ft.of First Floor: Cost of Construction:$ ` tc°'E7t9 ' Utilities:Sewer Septic Building Height: s 7Add me '+Ctya rodo B✓✓o rl e3 Name: ress: ? go S. 00�un t'•�t � f�/3Y Company: y: cT`C ri5t rl eC+Ci l'- State: �� Address: Zip Code: 3 y CSI Fax: City: State: Phone No. 30 h 1 f// Zip Code: Fax: E-Mail: 6-6(v ny, I I I,4 a i c OOLI .C or►l Phone No. Fill in fee simple Title Halder 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. ffitffiffiElm, 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: 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. 4� s _Signature of Owner/Lessee/Agent Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledgedbeforeme The forgoing instrument was acknowledged before me this��.day of �y y 20 Lby this day of 20 by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary blic-State of Florida ) Signature of Notary Public-State of Florida) Personally Known OR Produced Idertti tAS 6rsonally Known OR Produced Identification t�C'N �� , Type of Identification Produced '1=" L- U0 _ _stag�� '';Z`g�X�pe of Identification Produced ryojatY a es���,,i� m x nt �5g7 Commission No. .(geld EE sajnmission No. (Seal) '� �_' ""„r��aslo� tior,alMotary y Revised 07/15/2014 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS