HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5[A-7 ) 11 Permit Number:
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 'If
PERMIT APPLICATION FOR: fit- I C chwocle,ouA- _ U �e- �� U Kt -
Address: _l AqLo I le -5 ?oLV&. 7-ren5e-A �(.V) 3U957
Legal Description: ! V t�� t'1 e6 TS — L.. 0, Cznd "-an li I �&wcPJ 1,Aqb �
*J�o - f-oScx- -Sho&_ e, in m mbn cl e.me--s
Property Tax ID #: *50A - 501 - I q33 - 00D - o- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�-1e, waNr�er - (_.► e
7ra-v,e- 2 4 -on, ht Seer W ; 911 K-43 hQ-J- 441 jeC 3 7,? q4 ?Co
(�a3Co7 3Ce m
E ION INFORMATION:
:)nal work tote per of rmecf under this permit - c--FiecT� a
V echanical _ Gas Tank _ Gas Piping
apply:
Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:Sq. Ft. of First Floor:
Cost of Construction: $ z104 Q,' 'D Utilities: —Sewer _Septic Building Height:
Add3e:?�,
—/chi'4u M pAle-6 914L. Company: )&TYV5 �f1rL�eJ✓ U
City: q -v - � _ State: Vii- Address:
ZipU9s] Fax: City: F- . Ai .eW'G-e-- Stater
Phone No. D5 `7aZ.D •, 236t3i�P Zip Code: -349614 Fax % )(.Ow-yglI
E -Mail: JA Phone No `7`703 -c5a2- X377 Q�t��a)3�g-
Fill in fee simple Title Holder on next page ( if different E -Mail QYS bj' m yzW.-L-
from the Owner listed above) State or County License 1(0579
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: V Not Applicable BONDING COMPANY: "Ot 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 in pection. If you intend to obtain financing, consult with lender or an attorney before
commencing rk o ecording your Notice of Commencement.
Si ur Owner/ Lessee/Agent Sig o tractor/License Holder
ST OF FLOR A F FLORIDA
UNTY OFu e C NTY OF ���. i,—e� �-► c�
The forgoing instrument was acknowledged before me
this da day of 20_0 by
J()LM"\L
(Name of person acknowle ging)
(Signature of Notary P li - to of Florida ) �\�tttU111111111<<4
SA B R I NA L.� �`�NN '� k L. s 1.
Personally Known OR Produced lcl gra
Type of Identification :•moo �Ja��2.
Produced
Commission No. FF 1'9`5357
REVIEWS FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
tev. 7/2014
ZONING
REVIEW
•r,p
SUPERVISOR
REVIEW
The forgoing instrument was acknowledged before me
this CVJ day of jre, 20_LJ by
(Name of person acknowledging )
(Signature of Notary Public- State of Florida) tirt+�t1lFI11111p�
SABRINA L. 13L61IZ \� ,PINAL.��
Personally Known 1/ OR Produced I*Ftifj.e
'1pe of Identification
�oduced
111 111337 '^
3%_mmission No.FF t95,337 3� f y •a�
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PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW