HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED tt
Date: 3 3 6 1-7 Permit Number:
RECE1%"�:D AR J 3 701.7
s
ounuing rermit 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 ✓
FERMI I APPLICA I ION FUR: To Select from dropbox, click arrow at the end of line as '
FROFUSEU IMFROVEMEN I LUCA I ION:
Address: 133o5 MW BA\tWoot> PLAC( \
Legal Description: IVEiZ�EN 17 (22, (a 1—�1�1 L� r�7 Ib2' 3`i59—o25g7 1
Property Tax ID#: C4 70 3 - n 0 3 3 — N O - S Lot No.
Site Plan Name:_"V ,po tj D A m,-A :9 u r2v E Block No.
Project Name: "jj?_�44U DES 1 6E0GE
Setbacks Front l UD Back: qO ' Right Side: 85 / Left Side: 10
UEIAILEU UESCRIFIIUN OF WORK:
DJSTfFLL NEW SOD 6.014A) Ul(T 7A•NK (LP) ) RUN C,1CTEp.ro&2 6T4!S LioJE TO PooLIfE/{-TZ7/Z
PrMb FIRE p,T — CONNeCT.
CONSTRUCTION INFORMATION:
Additional work to be nerformed under this permit—check all that apply:
OHVAC Gas Tank [RGas Piping 0 Shutters a Windows/Doors
Electric Plumbing Sprinklers I Generator 11 Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $_ q3 oo • °O Utilities:[]Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name S40-0 M ukPNI Name: B 2 l A N C R UFO P14
Address: 13,305 A/0 AA A)LI6o A-Ade Company: C A-t b C b I veasrFie�ri
City: PA04 C-111/ State: P'L Address: '7cl Su SW SRc k -�_,qM es D2—
Zip Code: 3ggL70 Fax: City: 5Tu a RT State: FL
Phone No. 7'22 - 2-52- 43�3 Zip Code: 3Lf cl q7 Fax:
E-Mail: Phone No. `772_ 2&6, — L (a 30
Fill in fee simple Title Holder on next page( if different E-Mail: I �j Fo SR('. �iUEre�i�iE� •Colvl
from the Owner listed above) State or County License: al 0-72
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMEN I AL CONS I RU(;I ION LIEN LAW I NFORMA I ION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: 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.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 your property. A Notice of Commencement must be recorded and posted on the jobsite
before a irst inspection. If you intend to obtain financing, consult with lender or an attorney before
cc g Work or recording your Notice of Commencement.
— /U/'__� s
Sig ure of Owner/Lessee/Contractor as Agent for Owner Signature ofC ntrac rr//Liiccense Holder
STATE OF FLO�I� 1 STATE OF FLORID
COUNTY OF ►"I (L- COUNTY OF ��C�®" �
The for oing instrument was acknowledged before me The forgoing instrument was knowledged before me
this P day of M Atcl I 20 1by this�day of ��� 120 Z71by
SAILA411 H Uji? Py &n/l Gd�l�aa
(Name of person acknowledging) (Name of erson acknowled rng)
(Sig6afure of Notary Py lic- tate orida) Signature of Notary�>!R
tate of Florida)
Personally Knowr2a.
/ OR Produced Identification -� Personally Known Produced Identification
Type of Identifi ", .XF e ___ ' D �� Type of Identification Produced
�� r cE�J BUFFA
„. : '.1'r CCbIMISSI0 5�Fap W.PADGEITCommission No. �` t S;Jana 8213 Commission No. ;"�r�y MY�I Slla14#FF9M78
ndena2n ors }' ;f EXPIRES:January 21,2020
A Thill Notaq Puft Underwriters
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS