HomeMy WebLinkAboutBuilding Permit Application i
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ALL APPLICA LE INFMIJSY BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 19— Permit Number:
G -4
Bufliding Permit AppHocataOn ,
Planning and Development Services
Building and Code Regulation Division I
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commerciai Residential
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PERMIT APPLICATION FOR: To Se
PROPOSED IMPROVEMENT LOCATION; i
Address: C61,00 / c1.Saes A elc D1'.
, I
Legal Description:
Property Tax I
Site Plan Name: Block No.
Project Name: l"!Jit y lien PL e 4 rn r�,c5
Setbacks Front Back: Right Side: Left Side:
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DETAILED'CESCRiPTIO-N OF`vUORK:
("4 page. CA-8 w-'Ft, '1-0 flew LaAr CI-,
Pole, -30 r9 41 13 >tiC.Jaer C?rI e J# f8 t✓i C Af, r
COI�STRUCT1 N,1I'NF.0 MAT1ON:
:.Additional work to (enertormed under this permit-check a t t appy:
®HVAC L�1 Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric 47 Plumbing Sprinklers Ej Generator Roof Root pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
^�p c� a
Cost of Construction:$ � Utilities: �SewerSeptic r ( Building Height:
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OWNS k/LESSEE: CONTRACTOR;
Name F i lea Id, 4M )coop L L C Name: T
I
Address:_ 3y 3! oC un of l.dD. Company: b f-� �rLl�.✓= - c ✓t`�c; 44C
City: - c. Cu AA c4e,l in,t State: C I4 Address: C78`r`% �_ , r r. C,
Zip Code: J1 IC`1-6 Fax: City: (/+_-V-;, 1 State:F1
Phone No. Zip Cade: 3 2 `l{ ( Fax:
E-Mail: Phone No. -7 .6 SSS
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Fill in fee simple Title Holder on next page(if different E-Mail:- `tea,a��,?�c,;(�h o_e-oy+,,
from the Owner listed above) State or County License: 7- /300 Ctl;,�f
If value of construction is$2506 or more,a RECORDED Notice of Commencement is required.�
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SUPPLEMENTAL CONSTRUCTION LIEN:LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:! Not Applicable
Name: Name:
Address: Address: I
City: State: City: I State:
Zip: Phone: Zip: Phone:I
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EEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: . I _Not Applicable
Name: Name:
Address: Address: I
City: City: I
Zip: Phone: Zip: Phone: I
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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 covenantslthat 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 l will,in all respects,perform the work
in accordance with the approver!{dans,the Florida Building Codes and St.Lucie County Amendirients.
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 Coef mencement may relsitlt 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.lor an attorney before
commencing work or recording our Notice of Commencement.
1 t s
Signatu e o OsseeJContractor as At for Owner Sintp6 of Contb0taffLicerise Holder
STATE OF FLORI®A1 i STATE OF FLORIDA-:—
COUNTY®F�v`G�i�u� L� COUNTY OF
The forg-oing instrument was acknowledged before me The forgoing instrui�nt was acknowledged before me
this�day of�vi-aJ v 20(„q-by this�day of -/ I 20(' by
Name of person ackno edgin {!Name of p rson ackno edging
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ignature of Nofary Public-State of Florida) {SSgnature of Notary Public-State of Florida)
Personally Known OR Prod,uFedl tification �. Personally Known OR Produ d Id nti cation
°type of Identification Produced �� L— Type of Identification Pro dui ed_��
,�„� is A.ARZ 1 (r
Commission No. ilk `Q, I, . 8mmissi No. ,CRY p ,?a J0StA.ARZUAGfi
:. .�•, Notary Pub atftotida I ,.oa e,=.,�
” .•= Commission a!�f 962979 :_• .�„ Notary Public-.State of f 'a
y 91 ` z.
rp"I Sir- Z1, #FF962111
Revised 07/15/2014
'•%A„�;°`''Sonded tlitough National Notary Assn. �� o=G4 << Y�mm.Ex res Feb 21 .20
,. ,,; •�.......a Bonded through National No ".Assn:
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW” REVIEW REVIEW
DATE
COMPLETE
'INITIALS 1