HomeMy WebLinkAboutBuilding Permit Application`'All APPLICABLE INFO MUST BE COMPLET�V- �OR APPLICATION TO BE ACCEPTED
Date: MAtij / Permit Number:
RECEIVED JUL 22 20
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:
„x
Address: 'y bLe Al 5 ALAe—
Legal Description:
Property Tax ID#: igzl '�C7 0r O 1 0(e — , , 0 1
Site Plan Name: %,�- -t4 PbP-7—/svc4e �LL1 ��lc "
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No. -Z—
Block No. -7
Fr.
h��
Mechanical
1-1
Electric
_ Gas Tank
Plumbing
Total Sq. Ft of Construction: eI b O
Cost of Construction: $
Gas Piping
Sprinklers
Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof
Utilities: —Sewer _Septic Building Height:
gqC)WNER/L-ES�`EE e.."/IY�AY:,F��}r5
Eam.'4�i'£7M1i"s,6p:$^"'kcfiµf
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Name 'de-j- ' 5 % -
Address: 1 o4 - d s e./�d 1V le
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City:-'� i State:''::
Zip Code: Fax:
Phone No.
E-Mail:
Name: ,A ;6 �FiZz--zv
51-
,Company. •�" ,L /Z 2-
C LGC
;.;4d"dress: ��J Z SE l Oslo
City: 1 �1-Y4%T-
Zip Code: -5Lf % / 7 Fax: -7) 2 `?
Phone No 12'LiZ
State:
Jt/ / g � �j
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail It +"L7-o flu'S fV-
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: 5-1- 4 (- _ I-e (J_.
Address: 2-1pp, 0 t v- i + / "
City: "vrl-
Zip::3q `JtLL Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 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 the first i ection. If you intend to obtain financing, consult with lender or an attorney before
commencing i or recording vour Notice of Commencement.
of Odfief// Agent/ Lessee/Contractor
STATE OF
C UNTY 1
Ahe forgoing instrument was owledged before me
this '/ day of _ 20,45:'by
(Na a of person acknowledging)
( nature of Notary Public- tate of Florida )
Personally Known X— OR Produced Identification
Type of Identification j7A!
DAINA S
Produced
MY COMMISS
Commission No.peg EXPIRES Au
�
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Contractor
STATE OF FLORIDA II
COUNTY OF l"lu� `f
The forgoing instrument was acknowledged before me
this �,o day of 20 15- by
(Name of
ng )
(Sign atur o ot7ary Public- State of Florida )
Person,olly flown
ilTl n n I EDGAR I. iAPIA
�Zd ITS � 0 �� Public, State of Florida
1 #YFF150377 : Commission# FF 140697
scomr2i6sip No. My com(>Sniles July 26, 2016
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