HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n/\
Date: /d -8-/8 Permit Number: /8'(0 -OI 1 u
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INFT RECen/eo
W Building Permit Application OCT 0 82015
Planning and Development Services permitting p
e
Building and Code Regulation Division t•Lucie County nt
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential V
PERMIT APPLICATION FOR:
..PROPOSED[N'PR®VEM 'LOCATI® g: . : J , ..: w r g; ;
Address: .32S0 S . 7221 Si: ,C 7 P/EZ ee
Legal Description: 11/9?EA ✓/LL a4/e,pei✓J -f/J-l/N rilizcE -J' /Za_cy Fr
L_PT /8o- less- Ety 890 c- (0/2 3723 - / /419)
Property Tax ID It: 24/27-6.0/-ODS - 01v -2 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
AILED DNCRIPTI®N�a WORK:
.
Re?6,4 i 'e'' r or Ek/ o1l1J lA✓/711 .c/J //1",4 e7
x LC Jr vN/ !-r .: G✓ir✓doo ws 8ei/✓c2 r 1D Ess f Y dw.✓E2
/y Allit/Av 6ws -
CONSTRUCT Q ►.. INF®°4M°TI®No ^ 9k, :
Additional work to be performed under this permit-check all that apply:
Mechanical Gas Tank Gas Piping Shutters ' Windows/Doors
—Electric —Plumbing —Sprinklers ' - . Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of-First Floor:
Cost of Construction: $ / Z Utilities:," —Sewer ____k-Septic Building Height:
OWNER/LESSEE° �_ C®NTRACT®R°A
Name J 11 G•2.OUi✓] Or JLL/ GC C -Name: -. J/,)(1 7. it/,t/G/
Address:le 7 /1,4/ .v1 jNai✓1S en Com,.h/,y y Company: ec✓T2C H ,ie c LAG -
City: /✓.1-6(/ EAG/-/ State Address: ,/.1-132.-.1-#1../ ,46oCil c�i✓.!/�C,_ o91/6-
Zip'Codes 7Y5'S"7 Fax: City:..7b,ZTJT «/C,C State: FL
Phone No:..: ' / + 74s - ?q8O Zip Code. 3 yes-3 Fax:
E-Mail: ,Phone-No 77 2-- 92e/--6.76 4i
Fill,in fee simple Title Holder on next page(if different E-Mail Jc71/i✓GD Ei✓271 IjbHEJ- ea H
from the Owner listed above) State or County License e/2_i /3Z4'AQ /
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUP°LEMENTA LCQNSTR CTI@N I f@RMAT ®Ns'. :' v_
DESIGNER/ENGINEER: //'Not Applicable MORTGAGE COMPANY: A/Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone: /
FEE SIMPLE TITLE HOLDER: vot Applicable BONDING COMPANY: V 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 represu
sentation that is granting a permit will authorize the permit holder to build thesubject 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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
Signature offlown essee/Contractor as Agent for Owner Signature ontraLic' ense Holder
STATE OF FLORIDA J STATE OF FLORI A
COUNTY OF C,ic—e COUNTY OF -_ L UGpc__
The forgoing instrument was acknowledged before me The forgoing instrumen was acknowledged before me
this day of 1' ,20 /6-1:0y this y of 0C/l ,20),,
Si i' Sir) C S oP- +12 32)1n d_z _
Name of person making statement. Name of person making statement. �/
Personally Known OR Produced Identification Personally Known .OR Produced Identification i7`
Type of Identification Type of Identification ///
Produced Di---- C
•
,_ $- y // quitr, T
A �£4, S/J /J / ►'Y , .� ,� �� a n '�_
(Signature of Notary Public-State o /"orida ) 0 (Signature of Notary Public-State of Flori.,: ' •9 1
CI-
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Commission No. (Seal) cc 3 °> ; Commission No. (Seal)*T�3®�
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REVIEWS FRONT ZONING S "p PLANS VEGETATION SEA TURTLE m FGie, •_ ,
COUNTER REVIEW ;' I REVIEW REVIEW REVIEW '�, I-
DATE . .N—.C. - I ^'m�o�
N c 33� ,„ d
RECEIVED `° v o 'I ^',•CO-0
DATE
COMPLETED F'
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