HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 Permit Number:
R E C E 1'.' D PEAR 13 2017
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 IMPROVEMENT LOCATION:
Address: csudr) 11 &r(-NT W. Av--e— I� T\-t_!ocC-e_ ��-� 3�cis1
Legal Description: J`-�b'� 1� ��0.r n Pin Rx-p-
Property Tax ID#: WL\ - a0ET1 — a00-y Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: �a,L Right Side: D• Left Side: I Q•
DETAILED DESCRIPTION OF WORK:
13LC,kol , 5 \`tr757-k SC(eentvOA-- u rT� �.�+r_ ALk.iv.un �vo�
CONSTRUCTION INFORMATION:
Additional work to e apply:
0HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing ❑Sprinklers Ed Generator FI Roof Roof pitch
Total Sq.Ft of Construction: 7S1 %Y Scl.Ft.of First Floor:
Cost of Construction:$ Z2 49r D Utilities: Sewer 0 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
ame J C�mt Y art U. Name: d�V �tA 1 IN\.�N�r
Address: SS OI Company: A-O► 0.1 L-1, C,-)r,&A-►'rk c An rin
City: �b VA- f I-e r'C.-L- State:FL- Address: -';R. 5 5 t` 5A-
Zip Coder 4 of�� Fax: City:'F-U v-- R e.YC-e_ State:,2L
Phone No. '9SU • b 05 - rl 1 ke 3 Zip Code: S4 q 9 l Fax: �4 to 1-302,5'r
E-Mail: Phone No. `Yl%l ^ 0 D
Fill in fee simple Title Holder on next page(if different E-Mail: ZLZ
from the Owner listed above) State or County License: C.B C 125`),-N
,J value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: LA.QU.V,\ Name:
Address:IS13 CerucLk Places Address:
City: IKO U( 11 a c e R State: - City: State:
Zip:_r�2jn Phone:"l'17-01SS- In ySAT Zip: Phone:
FEE SIMPLE TITLE HOLDER: w'Not Applicable BONDING COMPANY: _ of 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.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 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 yopr property.A Notice of Commencement must be recoroo and posted on the jobsite
before the first i ction. If you intend to obtain financing,consult with er or an attorney before
commencing r or recording our Notice of Commencement.
s
SigZE
Owner/Lessee/Contractor as Agent for Owner rTATuErdOOF
f Contra cense Holder
STF FLORIDA FLO A
COUNTY OF �� L�e . COUNTY OF . -t
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 3 day of ���� 20 0-by this G day of 11�0XLmJ-_ .20 V) by
RAUML
(Name � n ,-- 1AMARA VILLARUEL Name of person acknowledging) `�2pt�Y°�e(c� RACHEL TAMARA LARUf
(Name of person ackn * ,° Notary Public-State of Florida
.•, * . _ Notary Public-Sta of Flor:
Commission#FF 949442 � ��? Commission#F1 34944-
MY Comm.Expires Jan 11,2020 -'% OFFS � My Comm.Expires 11.
(Signature of Notary Public- to e o F n (Signature of Notary Public-State o
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced KIO` R%W 16t log l tago Type of identification Produced fL& N
Commission No.PE 2 44 qLl Z (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE 3 3 1-7
INITIALS