HomeMy WebLinkAboutBuilding Permit Application[n .
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED j� 1 n
Date: / Permit Number: I J�7 •
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Building Permit Application :
Planning and Development Services . APR 13 2015
Building and Code Regulation Division �OtOG5 Me��- I�
2300 Virginia Avenue, Fort Pierce FL 34982 I T1IN
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Resige�i����".,
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line , ,
PROPOSED IMPROVEMENT LOCATION:
Address: J 2 (P 6Z✓Yi Abe ,ed. F-1A /, Ee 1- ' P, F & c34
Legal Description: / ; 3 1 /\/ A 6)' /IJAI I SA% 1 4
S'
Property Tax lD #: 42 3 D 1 - q3 a - 0 001 - 0 0 0-- S' v Lot No'
Site Plan Name: Block No.
Project Name: C—M,00c) 6S e,S/di?A('-e, L,-� I jai,'_
Setbacks Frone Back: 7 qs— Right Side: 30. 1 Left Side
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to e nerformed under this permit- c ec a apply:
E1HVAC Gas Tank Gas Piping _ Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator EiRoof
Total Sq. Ft of Construction: i' -7 1 5 . Ft. of First Floor:
Cost of Construction: $ . o2�Q 000 Utilities:0Sewer L'Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: l&)A_X� OW
Addr s:
City: State:
Zip Code: Fax:
Phone N '1-91- 510"
Company:
Address:
City: State:
Zip Code: Fax:
Phone No.
E-Mail: Q I C] 0a -f,7G(24qC7L= LA> V
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER - -
-Not App II ca61e
MORTGAGE COMPANY: Not Applicable
Name: r,pbcLc-L�'l��S(.
Name _.
Address:
Addr s�" QSJ
it Cce-
State: _
City: State;
.Zip: Phone: ' c
- 0
Zip:-' Phone_ -
FEE SIMPLE TITLE, HOLDER:_ _
No Applicable
BONDING COMPANY: _ _Not Applicable
Name:
_
Name:
Address:
Address:
City:
_ - -
City., - -- =- ---
Zip:. Phone:
Zip: Phone:
__ .. _... I certify thatnawork,or installation has commenced prior to the issuance of a permit.
St. Lucie County makes -no representation -that -is -granting -a -permit -will -author- ze-,the-ppermit-boldeFto-build-the=subject structure
which is in conflict with any applicable Home Owners Association rules,, bylaws or -and covenants that -may restrictor 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 ou'c Notice of Commencement:
s
Si F tine°of Ow, /1 Lessee/Agent le * Signature of Contractor/License Holder
STATE OF-FLORIDA e STATE OF FLORIDA:
COUNTY=O m;#.': COE}N-rf-GF - - -
-- The orinstr ent'viies acknowledge thefoie �g �' : The forgoing instrument was acknowledged before rrie
— •o
thisday of 20by: 2 mm9m" this : day of 20 by
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(Name of person acknowledging ). -_�_ (Name of person=acknowledging) ,
(Signature of
N a.ry Public State of Florida) at (Signature of Notary Public- State of Florida )-
Personally Known OR P uc d Ident icatio Personally Known OR Produced Identification
1,. r` .. T ' e of Identific'Produced.
`Type of Identification Produced. YP ation
a..._......
-- .. ::-...
Commission No. �°- -� tSeal) -
-
Commission No. (Seal)
Revised 07/15/2014
5
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