HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 3a l'1 Permit Number:
r e17
I] �i �� _ RECEiti rD JAM �a_-�
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: �r�1�`.��•`Cq
PROPQSED iN'P 'O ` E�MENT LOCATI'(TN:
Address: &ZA4 Wa-r--r0ATa-n 1)ncvc, ca--r PI G r?_C_1_:r 34 9 T
Legal Description: PM rz c c 1_ #$ 24 33- bol -c:'OD I - 00018
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name: SL�0L-:'C-s oATC2 Ay-rooAA i loot/
Setbacks Front Back: Right Side: Left Side:
DT LE� DE=�SCR� P =N@
jNS TALLIh/G AVG I E LE c.-r�c c v PP 1-H . A rdb 1h1S?ALUkj4 Ay ToM A--r1( �ATc c-)PL rtnTbvu
�►n1 TWo 'L_I c.F+TS To 6ATC LoL MnJ S
CONST liCT10 N'FO'RMAT10'NI
Additional work to Be performed un er t is p—ermit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ o-o_5 - o o Utilities: —Sewer —Septic Building Height:
OW R l.E56_315 CONTRACTOR;
laA-76-„ Ftcaa Name: 5C7H6�J' I A;`Jc=s
;Address 2'Zq� rScJt� ,,.aTeYK �2ivc `Company L cS- 'SL-Cy21_i.:j )h!f-
�'@►2 i _
:City: r'`�c- cc
State: tL `Addr.'ess:
Zip Code: 34.115► Fax: ---- City: ST OAR-i State: /L
Phone No. Z Z2 S2-p 2( 42 Zip Code: 31-t `fll Fax: -1'2-283-m2-9 L
E-Mail: Phone No SC.I - S 7 S - 0000I
Fill in fee simple Title Holder on next page(if different E-Mail ecS�1 vs j�) AOL. Co.•,-.
from the Owner listed above) State or County License L c- QP638 66
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUP E A +SON TI U 10 L E W I F®R�MAT110
DESIGNER/ENGINEER: _ - Not Applicable MORTGAGE COMPANY: X 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, l 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 recording our Notice of Commencement.
Signature of-AJ Eessee/ on cto as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORID !�
COUNTY OF_f�}ter' (�esv�CA COUNTY OF f}LM L��r} C H
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this-k ''`day of �1 u w 20!�–by this_`+flay of �/kNk�/ 20/ 3- by
(Name of person acknowledging) (Name of person acknowledging)
(Wa6re of Notary Public-State of Florida) (Signatidre of Notary Public-State of Florida)
Personally Known OR Produced Identification r/ Personally Known OR Produced Identification
Type of Identification
LESLIE REINHARDT Type of Identification
r'""'•.
Produced C��-.�r�" "i,� � Produced 6-A - kAW41
* Notary Public-State of Florida, ,s ..�.,, LESLIE REINHARDT
.•; My Com Expires Jun 2,2018. = . `�+ Nota P c-State o1 Florida
Commission No. moo;: Cb Commission No.
Ion#FF 128473'. - .•? My C xplres Jun 2,2018.
otBonded7WouviNationalNotaryAssn. +� oP�°;� commission#�FF 128473
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW . REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014