HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: to! i 11 :.., ) 10-p00A
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)4621553 Fax:(772)462-1578 Commercial Residential t -
PERMIT APPLICATION FOR: To Select from dropbox, dick arrow at the end of line
PROPOSED:IMPROVEMENT:LOCATION
Address: oko$-7 L 1 CA. \-2-0\(( Pil,v'cr.j FL M ot51,
Legal Description:oA(1 -5L1 3Q -V\f c ?arra- - 5-EC c�S 5\r)O 111 or
.Z7)Z0-1(M1.&' 10}- 101011 Oct ( V .1 z1 LOe1 .115C--6;O1c6S Cor u10c1-14
Property Tax ID#:\`:JC0‘Ii— \-60 6 V O Lot No. 2 q
Site Plan Name:��icxyn$ v_6\1....e5, -vG1r\NSO. Block No. �08
Project Name: //
� O �
Setbacks Front Bacic Right Side:: . Left Side: /
DETAILED DESCRIPTION OF WORK::
-tti 1l 5c. JC.. P a fk`o 0 G J
CONSTRUCTION,INFORMAT_ION
Additional work to b rtor ed under this permit-check all apply: n
1:1HVAC _ mGas Tank L JGas Piping - _Shutters Q Windows/Doors
ElElectric Q Plumbing EJSprinklers 0Generator Q Roof
y -
Total Sq.Ft of Construction: 020 0 .Ft of First Floor.
/ra-
Cost of Construction:$ / / 0 0 °-(' Utilities: Sewer 0Septic Building Height
OWNER/LESSEE CONTRACTOR
Name 0 1M \J 05 1r1 0 f 4 n Cs
�1 Name: iii
Address: 10 o9-7�i \o 1'Q Company: grdt��' Grpvies rKvr-4 •
City: . U 4 P L QYcQ. $tate:Pt- Address: 6j C l3 Eck Ir 1e. cL- , -
Mp Code: ?$kCk\ Nil
Fax: tiiy: Ft if'f etec-eState: PC,
2
Phone No. 71 -2A Q1 IL-162 Zip Code: 3i�� t Farc 7 7 4` 61 17
E-Mail: A/1 fig" Phone No. 7 7)-+44l-'�'3 6 y
Fill in fee simple Title Holder on next page(if different E-Mail: �(t 18- Cce u Sf e.ad f CO,Li
from the Owner listed above) State or Countcense:� .
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
1
•
DESIGN ENGINEER: Not Applicable MORTGAGE CO ANY: _Not Applicable
Name: • Name: • -
I Address: Address:
I atY• State:_,___. City: State:
ZIP: Phone: • Zip: Phone:
FEE SIMPLE TITLE HOLDER:7 ° - Not Applicable BONDING COMPANY: Not Applicable
Name: - Name: - -
Address . - x Address -
City: - . . - City: . .
p; Phone: Trp: Phone
I certify that no work or installation has aormnenced prior to the Issuance of a petit -
St.Lucie Countymakes noaffp=ton that Is granting_ a mr-_
In contact vAth RvAll authorize aminwne —Me � n restrict holdw to bold the sublect such
e. consult OwnersAssociadun r�iwyour deeedamay r
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 appmved plans,the Florida Building Codes and St.Lode County Amendments.
The following"buflding permit applications are a enwt from undergoing a full conn rent review:mom additions,
accessory struc.tures,swiinming pools,fences,wails,signs,saeen.roomland accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result In yourioaying 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
comm ' •B work or recording your Notice of CommericieMent. ,
MIT
-3 t-_., .• r
:, re of Owner/ 1-, -Lasses. - - -.: :, I -of Contractor •_ • Holder- I l
STATE OF FLORIDA , STATE OF FLORIDA -
COUNTY OF .S-1�. �,o , COUNTY OF .)r. _,,
a
The forgoing instnirnent waS adQawledgeibefore dine The forglD instrument was admowledged beforemne
L
this _•day of r*. ,-20 ,
O -- -- - this l .day of Qcjt ' ,20_11 by .
L-14.bk,i.P.),,ZN efa„ . LA—A./W.0. 1 1.. 0_J.N.00..N_ ] - ''
of person adcnowledgIng) ,Name of perms )
O. %� t .... .� o Public-State
Yi_i ! I lr. lc� ) - ,,, I : ofNotary ) -
Personally OR Produced Identification
_ _ entification • Personally Know• n OR Produced Identification
Type of identification da
pro .. Type of Identlfieadon Produced
4 ,02%, INGRAM- LASHAHNA ,-. •' -
Conunisslon No. , •'i°1-i k14.NNotlFloridalic•State of FI J Comm�lon No. 1 ^-•, �=_�� ����
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' ?� " • *Ceram Expires 94.9 20,2018 a ,•tPp Pie LA HAi1NA IN@f�AM
�-,��� a iGll:u , .1 `~ i 9A. �Tr ,.. ="i'1r-"ti�`4+'� Notary Public=State af-Florida
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", Beaded Woven National Notary Assn.7 , 7 " ' ' ' ' '""`" ' `'
Revised 07/15/201 ���,"
tea. -.L„- ;,gr;;;P•• Commission; F.�1 7729 9
',,it4-0 Bonded through National Notary Assn.,
REVIEWS - FRONT ZONING SUPERVISOR ' 141W5 VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE -
COMPLETE
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