HomeMy WebLinkAboutBuilding Permit Application I
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: y1T41 (1 Permit Number:
—mgRECEI\trD APR 24 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 IM`PR®VEMENT LOCATION:
Address: IS a ob . nceAnAG Ayt,, f r'i pi-c- Le„ f'L,
Legal Description: 1 3S 39 W A 13 cr S W 11q O C fjiw lg55 N qv; F+
a%nC If56 Ra As In pb aa-go- 41•'76 A(.) or (1"--0o
Property Tax ID#: n d�?Ol - 33-- CMG 10 in(-b--7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
®E3TAhLED DE�SC�R�I"PTI'ON OF WORK:
fie.Move. non Qcr,;}► ,, %bo r- }0 +ht. deraki n9 4v%6 nCAA tO 4OCk-0
1Y1S�a11 f12,vJ pry �r1 �al� vn�er�Qyn�wn�
(Y1SWA new 601 F u b Mit}al Paur%Ab
CONSTR�UCTI®N IN'FORMATI®N:
Additional work to be nertormed under this permit—check all apply:
�HVA Gas Tank Gas Piping _Shutters Windows/Doors
Electric ❑Plumbing` Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction.. 90 ff�-'� S . Ft.of First Floor: 9 F02 �'
Cost of Construction: Utilities:0 Sewer Septic Building Height:
OU AONR/2E-8-5EzE: CON,'ITi CTOR:
Name Sings_` Y CAY CSOC k` Nanie: 1 ' I � �►y2 «ob�.�101 1Y1C.'
Address:10. IS A Company �ir WC 066Vi6A
i
City: POr� 5 IV�i�G Stater Address:_�(n01 COf U�:na Ayc
Zip Code:34 C)S 3 Fax: City:14ef1 State-IL
Phone No.*70,2 �d 1 1 Zip Code:1)1JQ51 Fax:
E-Mail: Phone No. '1'1a- !J04t- a 3B Y
Fill in fee simple Title Holder on next page(if different E-Mail:•641 GIB a w\
from the Owner listed above) State or County License: .&&..e�gGd 'S`1 q
If value of construction is$2500 or more,a RECORDED Notice of commencement is required.
SUFFtEMENTAL CONSTRUCI'L0N VIEN LAWA IN' FORMATI®'N:
DESIGNkR/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name:_rrylnf 2Ga ;L Inn. Name:
Address: So Ave, Address:
City: State: City: State:
Zip: 4 Phone:'1'10. Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: XNot 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 Countyy makes no representation that is granting a permit will authorize the permit.holder to build the.s'ubject'structure
which is in contlict 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 urfdergoing 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 ' spection. If you intend to obtain financing, consult wit lender or an attorney before
commencin o recordlpg your Notice of Commencement.
A "V4�,,,,
Signature of Owner/Lessee/Contractor as Agent for-Owner Signature of Contractor/License'Holder
STATE OF FLORIDA STATE OF FLORJRAI
COUNTY OF _S COUNTY.OF
The forgo ing instrument was acknowledge before me The forgoing instrument was acknowledged before me
this day of \ 20 sty this`�,_yday of 0► 20 by
CNN 0, Q 1
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary PubliLUState of Florida) (Signature of Notary P lic-State of Florida)
Personally Known OR Produced Identification ersonally Know �ideuti' � _'�
Type of Identification Produce pe of Identific or}tC6t9�uced r�tE(oIVENS s
D ' ':� Y COMMISSION#GG 022023
Commission No. = mff .. �p�JIMISSION# 2020 mmission No. •,A('IRES:De I�16,2020
ES:December 16.
° °= ni NDtary Public unde�wril .;eoF F�o,r Bonded Thru Notary Public Urdervni;er.
''rFOiFV�` Sonded1
Revised 07/15/2014
REVIEWS FRONT' ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS