HomeMy WebLinkAboutBuilding Permit Application J
All APPLICABLE INFO MUST BE COMPLETED FORAPPLICATION TO BE.ACCEPTED
Date: g Permit Number: 5
Building PermrtrApplicati n ✓GNL �J�,,
Planning'and Development Services it,eps
?"p
Building and Code Regulation Division. .
2300 Virginia Avenue,Fort Pierce FL 34982 �47,
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential Com'
PERMIT APPLICATION FOR:
PROPOSED tN'PROUEMENITI LCAT I N:
Address: = �� i,c,c, L e: :/ =AC= 4
Legal.De `ription: n. 9109-L-,
0 -L-, O "-TQC Ir Lfk-4 3
Property Tax ID#: y 0.1 6 0,9 !, 0A2 `P 0 S(t.Lot No. AQ
Site Plan Name: Block No.Y -
ProjectName: ez—I V-% (.UZ-S'O N 72 4-If
Setbacks.t:: Front Back:.Right Side: ,,,//1l;' Left Side:
DETAtLEd DON OF WOR
O' / •� vG% �'x ... -Il ' `�l.�l � G Na � l�elm !T
,Nrs w
7—W t<( c /-j!N 4 . p,�I L4 ,N:g cN 6M 4-, GGA --'/ Z.
CON�STR�UCT(O NFORM TION:
itrona, war to a pe orme un er t is permit-c ec. a 't at 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:
Costof Construction: $ OCA_ Utilities: _Sewer..,, _Septic Building Height:.
O NE /LE�StS �E. CONTRA: OR:
Name .+ CGLC •. 'n ZLS
it G Name: . /A
t _
Address: b L Company:T�rArgeTepm (�;rf4Db fLU ' C
City:. tL__U State: JI-L Address: �`.1 S'.w• �P 4"G� it Qj 6 4.""yI"
Zip Code: y �{ $� Fax: Cdr'//J City: r,�1. c. State:_
Phone IVo. S1O 7•- `9 7 •02 y g..a Zip Code:'3� o1 tc> Fax:
E-Mail: ? G� Phone No '7 71 -Z 8s=06 (Y
FilLin fee simple Title Holder on next page( if different E-Mail'-. C�+ It Ao,v 1 -7 6 ::of, �toG. CGw�
from the Owner listed above) State or County LicenseC& C DSa j ; 0l
i
If value'ofconstruction is 2500 or more,a RECORDED Notice of Commencement is required.
Sl1 ''PL MENl'AI OWN' IN,N IEN LAW INFORMATt®N:
DESIGNER/ENGINEER: VNot Applicable ' MORTGAGE COMPANY: '4--'Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone. Zip: Phone:
FEE SIMPLE TITLE HOLDER: `-Not Applicable BONDING COMPANY: _ of 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.Ow,ners 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-]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 or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor s gent for rfii ,•'` Signature of Contractor/License Holder
o
gy
STATE OF,FLORIDA - Com . xo STA nETOF FLORIDAA � o
COUNTY OF -tel Z D COU OF M
se so
The forgoing instrumen was acknowledged before m w � The forgoing instrument was acknowledged before
'me
this2\ day of W^�� 20 l by �T 0 this_day of ��""'�� 20 jk by o T T
(Name of person acknowledging) "(Name of person acknowledging)
axzaea
(Signature of V
ryPu Iic-State of Florida (Signature of V6 aryPu/blic-State of Florida)
Personally Known �OR Produced Identification Personally Known °� OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission NO... s. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW. REVIEW REVIEW REVIEW -'REVIEW'- REVIEW
DATE
RECEIVED
DATE
COMPLETED
Te—v. 7/2014