HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � �� Permit Number: ( ���- �C/� `�•
I
RECEIVED
E .
Building Permit Application MAR 21-2012
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:
1P.1 GNPROUE E!NT LO:CrtATION:
Address: IU .cam.•-c 3
Legal Description:
Property Tax ID#: t7)�/�- 195- �(%�� �• Lot No.
Site Plan Name: Block No.
Project Name: ,LSA E-W"6-�, TOS
Setbacks Front Back: Right Side: Left Side:
ETAILED DE�SCRrI'PTION-OF 11V'OR� :
1rve�il/ y
-
.. i-- c
I _
�CKYNS��TDUC�T& j=`AT1,QN___
Additional wor to be pertormed under this permit-check all that,appy:
_Mechanical _Gas Tank -Gas'Piping _Shutters _Windows/Doors
_Electric j _Plumbing _Sprinklers _Generator _ oof.
Total Sq. Ft.:of Construction: ' O U Sq. Ft.of First Floor:
Cost of Construction: $ (0 7 U Utilities: —Sewer —Septic Building Height: /0 or
01`IV" ER/LESSE: CONT_LRAM®R:
Name I GP W L Name: kvttLl 41, c4v
Address: 7 Company: A e
City: F` ���-•- � �SC��'state: Address://,r
Zip Code: 3 y G 1/ Fax: City: A)--7 }-
Phone No.� f Zip Code: 3�19 .6 Fax:
E-Mail: Phone No 77
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License o 0 S
I
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S JPRLEMENTAKe N'
LIEN LAW INIF®RMATI®N:
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,sign's,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 a,nd posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender oran attorney before
commencing workypr recording our Notice of Commencement.
n % N-
Signature o her/Lessee/Contractor as Agent for w �=
Signatur tr ctor/License Holder mSafWt LCV
� OOLO -�STATE FLORIDA aSTATE RIDA
�COUNT OF T
¢t 'Ca -
k�
ii
Z�w z
The forgoing instrument was acknowledged before ¢gwThe for oing instrument was acknowledged befox
this qday of_;"?)I*f?r 14 207by m this 7day of aW= 2017by .,W01
a
Tr ...... 0 n Tr V 4n
(Name of person cknowled ing (Name of person a nowled ing)
a 1A14A4-4 a�(zLIA i,e 4, 4 9 - 46
(Signature of'N ary Public-State of Florid ) (Signature of Notary P lic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014