HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO
�yMUST
nBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /' � b Permit Number: M-1.0 1-7
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Building Permit Applic DEC -7 208
Planning and Development Services'
Building and Code Regulation Division tting 7unilt)
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2300 Virginia Avenue,Fort Pierce FL 34982 .L Cie
Phone: (772)462-1553 Fax: (772)462-1578 Commercial R
PERMIT APPLICATION FOR: 4147 e E
REMIRS-ED 1 PRa►U�MEZ T OCAT O
Address: 7 fwhasVibnA "- c. ��•
Legal Description:
Property Tax ID#: 0 0`7 f/O Lot No.
Site Plan Name: n Block No. Z
Project Name: /� p, i` lkoict.
Setbacks Front Back: Right Side: Left Side:
711.
DE AlfLED DE�SCRiI�PT10N �F WORK.
G ' WAI. Vn V z rzhce --;Ln5�411a /boi
far C%� c�1 ar'y ' % 115
CONSTR+UC {C1N ( FQRMATION:
Additional work-to,_ ,e pe orme ,--under t is,permit-.cneck all t at.app y:; -
_Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
-'d�Ft of Construction: -33 Ft. of First Floor:
0'
Cost of Construction:$ Utilities: —Sewer —Septic- Building Height:
D` ER/LESS
LOW A, ACTOR:
Name 9Qb1401 MQG 6irlad to Name: Lh
Address: —1407 A b -40 Company: Ar iii v i i!5
City: rcvy-�- AllerGre< State: L Address: 7 3.9 f� /4
Zip Code: $YJ/51 Fax: City: 11'e- p B-Cach State:•
Phone No.^^ ZCY 5 - 05- k5PO Zip Code: 4( '?4716Z'?4716Z Fax:
E-Mail: �7`km a je 16 ,e ✓eDL- a imA Phone No 777,-OW-129W
Fill in fee simple Title Holder on next page(if different E-Mail �a�Jn•, r�hG.i�[LSo/v�� P W.
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUP CEMENT Ct?NSTRUG"f ISN I.hEN LAW INFO .3MATI®N.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _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 Countyy 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'Tules; 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 reco�d.ed�and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender dr an ktorney'before
commencing work or recording our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agen ;Qvi Signature of Contractor/License Holder
STATE OF FLORID $`X�,,a STATE OF•FLORIDA
COUNTY OF s =o o• COUNTY OF
NE
%The forgoing instru ent was acknowledge�e44.
f rz.]FE_ The for oing instrument was'acknowledged before e�Dz=
this day of C • 20/0 'b this day of �L G- 20 by �T=
C> Z7
C T S9 pV j
• IA�T 1 � �-�1 �� ��-< AVL g� lj -da az- i `°N
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of[dent ific Type of Id nti ' tion
Produced ` �r 1 it Produced (' •L.G " "
(Signature of Nota ublic-State of Florida) (Signature of Nota ublic-State of Florida)
Commission No. (Sealj;`. Commission No.` (Seal) i
REVIEWS FRONT '. ZONING -SUPERVISOR PLANS VEGETATION SEA TU RTLE;•:`•'IMANGROVE
COUNTER REVLEWWREVIEW REVIEW REVIEW. PREVIEW:,. REVIEW
DATE
RECEIVED
<DATE
COMPLETED'
ev.