HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: � 1
- . Building pp
Permit Application
Planning p 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' r
* • s 3< #
561
PROPOSED INPROV_EM�dVTpLOCATIN
Address: a1��'cparid. /" Y S- -
Legal Description: LF)i K E-7 I--uC I S+a4,(S JOAT f4Q. 0)`-1 e. L—
(012 L oc-c Y, c,5 D
Property Tax ID#: ,34at-� — '�1o3 DOC)L--> L tNo. 3`4
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
2.=-d C Ci?.y�fd .*� .S 5..x.,R'�^k'•-St}sfir.=e t,,d .5 t3i.'a�+r �-'.3;tY `£ c ='",'r �jd`:"-x'�'ls .,�`erm-+ ..a�,�.x G�k '..�`,
17Pxror:='etir"€.k3 eta
CONSTRUCTIOJVINFORMA�TION
° --,. .+x - a.x,aar*v ,J�.:'' k4 .3 �:`a^.�k'€._5^fi
Additional wor .to be pertormed under this permit–check ail that appy:
_Mechanical Gas Tank _Gas Piping _Shutters _Windo /Doors
Electric Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ (� � Utilities: —Sewer —Septic Building Height:
ag.
A
01NNERjLESSEE � �� �z.
Name m{-fir-41,n,I. Lo►-en.7 0 Name: FFre A D 5Q-)t..1
Address: 6-RK1'• Stinol Pine �2- Company: -I- .• I �C\ ��
City: PDQ+ 1.NCi--C State:_ Address: So , 62-ILLe i 40 24VA-
Zip Code: ?J q q(5 0- Fax: City: Stater
Phone No. r-) r19 -q rl i - 3 0.r--) Zip Code: 31M Fax:
E-Mail: Phone No '-?? 3LJ4- `1 I�
Fill in fee simple Title Holder on next page (if different E-Mail &` S--)u 641 rQ0-R N oct Ca
from the Owner listed above) State or County License C CC (3-5j,':) I
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
c , ¢ Jew urwwr�st; rix eyd aau €rx r� aa� arl x em
S;E) PE FNTAIOlSTR= T�fli� L,ir , . � .
7,�` ?'3,}�3-$.� �+`'�+",`li�:€T',+a. �ti^.�.r�z-,.+kms„�t.n "�•,,%•„� •'e�r.,-L.:,tt.".Y•;-.-v.�,*,�d�k�r-+'`;Ba„i.',�'ra-A,3`�.;�'•s�•�Y,rvf"�.Ti.1;<..+v.�;P�"4-���4'. er�-''��_ .•.�'-..?�*:-�''_S��,.°�'�£'�'"
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _NctApplicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _No 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 instE Ilation 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 thepermit holder to build the s bject 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 addition ,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-resic ential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your payi g twice for
improvements to your property. A Notice of Commencement must be recorded and posted or 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.
1
SigriaturVof OvVnerl Lessee/Agent Signature of c ctor/License Holder
STATE OF FLORIDA STATE OF FLORIDA 1
COUNTY OF �'+ �u -� COUNTY OF S ��
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of M O✓ ,2011 by this_,)— day of N O V ,20J 71 by
P ��re�j �44qm�.�Z��_j " j �'lwrc- �� ':�t rn 0 ('�6-�J
(Name of person acknowl dging) (Name of person ackno ledging)
l/� r
(Signature of Notary Public-State of Florida) (Signature of Notary Publ' -State of Florida)
Personal) Known OR Produced Identification Personally Knowf R Produced Ide ification
Y
Type of Identification Type of identificatio n CONSTAN E PROULX
Produced Produced = `
�TAMCe PFOU; GGIMAISSIGN r FF 160517
i�r
C� EXPIRES SeM miler 16.2018
Commission No. ��_ MY C&W)SSioy�ca'So ' Commission No. �N re a cam
EXPIRES Septamtrer.c.2011-
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014