HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COM ETED FOR APPLICATION TO BE ACCEPTEID_J
Date: Permit Number: Gam® L/-0S-qRM
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Building Permit Application
Planning and Development Services PER�il-ff1NG
Building and Code Regulation Division i St.1 ucje County,FL .
2300 Virginia Avenue,Fort Pierce FL 34982 I.
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED INPR'®UEMtENT L®CATIO'N:
Address: 9_1M iAAc.Lar,,L)oN
Legal Description:
I
Property Tax ID#: 340(4 �(O�OC "600, —WQ �- Lot No.
�Site Plan Name: F-e- . - ; Block No.
{Project Name: L%_ea Pd4�( __17ns4-._11e,51�O^
Setbacks Front Back: Right Side: Left Side: .
DETA LED DESSCR=IPTI�'N OF WORK:
CONSTRUCTION 1.NF0 -MAT1®N:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors.
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost o'( struction:$ } � Utilities: _Sewer _Septic Bj ilding Height:
/LE-M&EE: C®N R CTO�
Name 'F2(`tb: F Name ca LTL.3±1
Address":'.,." ��;C.� �` Com an $�,�a14'i,�1 �nS�-r.a r19�t��r� r►�cj
City: J�C k 2���/ Stater` Address: ( W er
Zip Code: Fax: City: A� �,^(-. State
Phone No. Ff0H-t-I5-1-3(AP 1, Zip Code: 33,+ Fax: ?7? 39-3-0") 5
E-Mail: - Phone No 77;i_, �Ll.s-^ c;=7 7L(
Fill in fee simple Title Holder on next page(if different E-Mail C1WW i n V_J_t �lU
from the Owner listed above) State or County License i!!!&ni,�(i bS
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUP'PLEME'NT/ L CONSTRUCTI + N RE' MEN.FOR�I\/IATI®N:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: hn<s `ow, Name:
Address: 1 v •s Address:
city: ems. R-'J-,dam State. I`L— City: State:
Zip: 33'Li-s Phone ��-- 3 i'3 Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: 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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
)a4A�ell� /� :O"iw
Signature of Owner/Less ntractor as Agent for Owner Signature of Contractor/Lic n e Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thiso°Z day of 20_ny this day of 20_ by
Gc
(Nam of person acknowledging) (Name o erson acknowledging)
( ' ture of Notary Public-St6b of Florida ) (Sig ture f Notary Public-State Florida)
Personal) Known OR Produced.ld zfieatio ,�' e,s' ally Known _ _O_R.Produced Identification] a
Type of Identificationt A� lid Qpre f Identification
Produced � Prod ed
19 . —I le y s °o yssn..
=r�, o ,# ion No.00, s
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Commission No ,•. _ i_ a!� ,r -�� �
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REVIEWS FRONT �`-ZONING SUPERVISOR PLANS VEGETA �SEA�TURT MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIE '`"A" 'REVIEW REVIEW
DATE �7 1
RECEIVED 'f
DATE
COMPLETED
Rev. 7/2014