HomeMy WebLinkAboutBuilding Permit Application 2
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date: .a 1�, Permit Number:
RECEIVED FEB 212017
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
:PROPOSED 11111-PR01/EMENT LQ'CATIC+Nr �s
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Address: 1 LAtlfitr YIST-4, IUA- Zoy "l7oR.T ST" Lya!t Ire
Legal Description: Vt!5-rA ST LUGIE -00-06 -7 Ur-17- Zoz lot 3Yr7S/g6()
Property Tax ID#: 3N2 Z- S-Oa -005.3+l�a`$ Lot No.
Site Plan Name: V_i Ss l CAI Block No.
Project Name: �� (�1/_15S 1r) all
Setbacks Front I� I Y Back:--N Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK r
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£CQNSTRUCTJQN INFORMATION $
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_HVAC Gas Tank Gas Piping M.Generator
Shutters Wind❑itiona wor to a ne Orme un er t is permit-c ec a appy:
p g ows/Doors
Electric Plumbing Sprinklers Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
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Cost of Construction:$ ID 1 K'oo Utilities: _Sewer[]Septic Building Height:
01NNERJI,ESSEE `' ` CONTRACTOR t ` g
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Name (ZISS 1 oAl 1�v6 Ct'36rr-4 Name: M tc� 6-nnwi N
Address: $ -7 LASE VIS-rA -rY1.4-1L- Company: _�_6NSpu "SgAc4 ^4164WA441
City: PoYu ST- LUGct✓ Stater-t_ Address: 1-17-2- ww IL-1..7
Zip Code: 3y4 fZ Fax: City: S+Vnvu State:
Phone No. 3q'245'7 ( 1 34 Z- (0S S`i Zip Code: 34 5 911 Fax: 61 Z- 5 7Y
E-Mail: Phone No. '7,77, - 65 Z -cP0qy
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: CGC I ry 6 Lf *3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENT L CC?NSTRUd-0 Lt� N LAIN INFaRMATION :
. � ., . 1 a
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: VAJ10 NogetS Name:
Address: WL Cou v►4n! 12-0 Address:
City: VUrtvr6k&WAV6AI State: ft.. City: State:
Zip: ,L)Phone: — /01(b Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. LucieCountyy 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 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 OWNE/You fai to Record a Notice of Commencement may re ulti your paying twice for
improvemf yoa Notice of Commencement must be recor ed d p ted on the jobsite
before t first' s u in nd to obtain financing, consul 'th- nde or attorney before
com ncin w or r Notice of Commencement.
s
Si nature of Owner/Lesse / ntra as Agent for Owner Sig of C. tra r/ icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST .U.Y'/ COUNTY OF
The for of g instrument was acknowledged before me The forgoing instrument was acknowledged before me
thi,/7 y of 20/'�rby thiV;?� ay of 20/7 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature -PJotary Pu/blic-State of Florida)
Personally Known � OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. ,•'tip"°�Al�, � •GAUMOND Commission No.
:.= MY O SSION#FF 173367 ANN M.WOW
EXPIRES:December 7,2018 '=4`'' -
:.= MY COMMISSION 1#FF 173307
: ecem er 7 2018 11
Bonded Thru Notary Public Underwiiters
Revised 07/15/2014 ra
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE /q
COMPLETE
INITIALSi