HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE C(iM'r�LETED FOR APPLICATION TO BE ACCEPTED
Date: ! " / i�' Permit Number: 1 LJ o l a3
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
RROm OSED IMPROVEMENT LOCATION
Address: U%VE .TEWSEIN i9tkc- J-
Legal Description:_&Es S/A W1 rPA r OF LoT-Iq LYa u of X,4b Ate/ Tj/L app4F: cc 3'I45T
Arspirof W r� v Mrs 5 2! ALZ orAt e* 774, H91
AG OV111.6
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roper�t�Tax ID#: �S fa - (, d oQ - Lot No. �—
Site Plan Name: &07T- g PA a-.e.LA. k , MYMS Block No.
Project Name: S ��l/ti.e L
Setbacks Front Back:_f O Right Side: 0 • Left Side:
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DETAIL ED DESCRIPTION O`F WORK €
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CONSTRUCTION INFORMATION
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Additional work to be
_ ZGasTank
m e 'under this p it-checka that app y
Piping
Shutters _Windows/Doors
—Electric _Plumbing _Sprinklers _Generator _Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ y Old (ToUtilities: Sewer Septic Building Height:
OWNER%LESSEE LL{ .CONTRACTOR" 1
Ni me Tr £ hh C [
?A $ Name: bKPIAN .., 6PISonl
Address: 1 QU I .yg& 'De.vt Company: AAkr, 1 Cau6ay V040MI4L
City: TeNSEK W/' R State: PI- Address:
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Zp Code:_341I5j Fax: City: - PiUR com, State: F
Phone No. S&(- 242- -*QsS Zip Code:_341990 Fax:
E-Mail: Phone No. I I2- 2 j - J 100
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Fill in fee simple Title Holder on next page(if different E-Mail: &Th4tC f Cowo F'Lu It.AJI. Cow
from the Owner listed above) State or County License: O SS U
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
I
DESIGNER ENGINEER• Not Applicable - ..,.:_
/ — PP MORTGAGE COMPANY: ^No#Applicable
Name: Name:
Address: Address:
City: State: City: - State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 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 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 1 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 6 P dwner/ gent/•Lessee, _S atuf Tontractor/LlcenseHolder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF �aj:�r
The forgoing instru ent was acknowledged before me The forgoing-instru ent was acknowledged before me
this5;W- day of !,u 20_�t2by this'•day of A&ft 20 Z7by
n �s�� • • • �n ���h
Name of pers n acknowled 'ng) (Name of person acknowledging
Si ature of Notary Public State of Florida) (S' ure of Kota Public-State of Florida)
a. -
Personally Known FOR Pro u c8fftl9tiE0�e _; ovally Known OR Produced'Identi
Type of Identification P �A - .state o Type of Identiflcati ' P o u •d.- N���`Y' "J�." J GG 03601 U
/� ,,•aY'Poe;a,,, Notary gion# 2020 ",.,� �om� Tres Dec 1
Commission No. �V ' ,•� r, E41fas Qec. Assn• Commission No. s' �1 i° IECxp "al wavy Assn.
s•s� e;= MY dth hNal+onalN la. '��;°F�:� Bon edthro�90
OFF,o Bonde roug
REVIEWS FRON)00;; ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW. REVIEW REVIEW REVIEW
DATE-
RECEIVED
DATE
COMPLETED
Rev.7/2014