HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMP�L . D FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: % ��0
6MANMEJ
D
Building Per Q' Applicatic0R' i aQ16
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:
Address: �5�� SJ 0a`^I-/-• f)I/_
Legal Description: 6yt _6/i&L.(
Property Tax ID #:
Site Plan Name:
Project Name: _
Setbacks Front
-//-- NO -- d/l 9'— 0 0 8'
Back: Right Side: I Left Side:
Additional work to be performed under this permit- check all that apply; "
_Mechanical _ Gas Tank _ Gas Piping ` :Shutters
Electric _ Plumbing _ Sprinklers _:Generator
Total Sq. Ft of Construction: Sq. Ff. of First Floor:
Cost of Construction: $ "�7 Z Utilities: _;Sewer _Septic
0
Lot No.
Block No.
Windows/Doors
_ Roof
Building Height:
NNI, NE11461@ 5111
CONTIA TOR:
Name Iv --,
==Nam 65L.`I Ate--/
Address: " tf
Company:
City: _ ��-a�r.C7 State: k/
Address:
Zip Code: Fax: q 6'� 5�L 3 - ��
City:' State:
Phone No. Q S—Y -- L-3 — o
Zip Code: Fax:
Phorie No
Fill in fee simple Title Holder on next page( if Afferent
E-M i it
from the Owner listed above)
State or County License
I if value of construction is 2500 or more, a RECORDED Notice of
is requrrea.
SUPPL �11/IENTAL CONSI"R,U ` N LIEN LAW 1110FQRIUTATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address: : I
City: f State:
Zip: Phone
,l
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:, -
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone`
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
I
Address:
City:
I
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 lof 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 wor-k�or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID -
"..
�
STATE OF FLORIDA
COUNTY OF LL;GG
_ '
COUNTY OF
The forgoing instr ent was acknowledged be
rR me
The forgoing instrument was acknowledged before me
this day of 261& b
- X
this day of , 20_ by
ms m
(Name of person acknowledging)
(Name of person acknowledging)
� �N
I
66 I
(Signature of Not O Public- State of Flon a)
(Signature of Notary Public- State of Florida )
i
Personally own OR Produced Identification
Personally Known OR Produced Identification
Type of Id nt is tion �
Type of Identification
Produced
Produced -
Commissio No. i (Seal)
I
Commission No. (Seal)
REVIEWS
FRONT
'ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014
'SUPPLEMENTAL CONSTWCTION'LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:l
Address:
City: I State:
Zip: I Phone:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING
Name:
Address:
City:
Zip: I
I
COMPANY: _Not Applicable
Address:
City:
Zip: Phone:
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. L Lie County Amendments.
The following building permit applications are exempt from undergoing a fu111 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 in§pection. If you intend to obtain financing, consult with lender or an attorney before
commencing wo or recording vour Notice of Commencement. 4 /
of
of Contra46r/License Holder
STATE OF FLORIDA �j�nn �)��, STATE OF FLORIDA
COUNTY OF 'u'.aQ�Y COUNTY OF ma",
The f�g�g�nst me a ackno ledged before me
this day often 27 20 14 by
L (- I ( " Ca n z.
(Name of person acknowledging)
"_ �\ 0 V r
(Signature o Not ublic- State of Florida )
Personally Known �011 Produced Identification
Type of Identification Produced
Commission No. eU"D 0(Seal)
2 a• Lucy Junan0
Revised 07/ 15/2014 _g My Commission FF 031223
lw tidr Expires 08130/2017
i 1Ji y�l�
The for oing instrument was acknowledged before me
this day of (� 2014 by
(N a of person;
(Signature f No
Personally Known
Type of Identificai
ICommislsion No.
edging)
a)
OR Produced Identification
uced
(Seal)
R; Lucy Juliano
r.'y Commission FF 031228
mod' Fxpves 08/30/2017
1.1 i l.A A A..
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
CZ,uIm
INITIALS
I -v
i
-z
C—
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: W s , 14 Permit Number:
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
I
PERMIT APPLICATION FOR: To Select from dropbox, cli
k arrow at the end of line
PROPOSED IMPR`OVEMENNT LOCATION: °��
Address:
Legal Description:
Pry WA4-0-, kiln P
ID #: 15) " ��a ' O �i� " aka''
Lot No.
rVPropertyTax
`" fie Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side:
Left Side:
I
DETAILED DESCRIPTION OF WORK:
trtc -r ,5 n v 'k-c7 G�L
CONSTRUCTION INFORMATION:.
Additional work to e e orme undert ispermit - check aapply:
11HVAC Ei Gas Tank Gas Piping Shutters Q Windows/Doors
_
Electric 0 Plumbing Sprinklers E Generator 1:1 Roof
Total Sq. Ft of Construction S . Ft. of First Floor:
I El
Cost of Construction: $ Utilities: Se er Septic Building Height:
OWNERAESSEE:
Name
CONTRAC TOOR'
Name: ��` = •� T %% i r
Company: C-B
Address: `�
Address:_ b� �7� G-F
p�
City: 5-}'t) -/�4— State:
Zip Code: o � 9 9i •'7. Fax:
City: J- State:
Phone No.
Zip Code Fax: 77��-14
E-Mail:
Phone No.7a•
E-Mail: _ ' �_ � _00 1*_n V(,hO
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License: 11
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
M o o l►IeJRoVi CLQ q 54 t V=004
-
14� 000S
CONSTRUCTION LIENLAININFQRMtATIbN
j t
fS,U`PPLEIIEIVTAL
y"Y
y
,�
t#; L
,keTv
'v n
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address'
City:
State:
City: State:
Zip: Phone:
Zip: I Phone:
I
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
Address
City:
City:
Zip: I Phone:
I
Zip: Phone:
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 authLze 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 ful concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms an accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commcement 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 ipection. If you intend to obtain financing, consult with lender or an attorney before
commencing wogor recording your Notice of Commencement! % 0
i 1 r1l _ _ 1 A .11 n _
%iiatiIfe of Owrer'/ Agent/ Les V / C
Signature of ContraFMr/License Holder V
STATE OF FLORIDA j�� c
STATE OF FLORIDA
COUNTY OF �.
COUNTY OF 1�-i/
Theaf !Ipiinst met a ackno ledged before me
this day 20 14 by
The for oing instrument was acknowledged before me
this day of 2014 by
of
(Name of pe(ro-n1/a/cknowledging)
(Na . e of
person ack wledging )
0
kl�l AA
(Signature o Not ublic- State of Florida)
(Signatuire f No b ic- a of FI rida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identifica ion roduced
Commission No. U I (Seal)
Commission No. (Seal)
lubfic tole of Florida
ublic State of Florida
Lucy Juliano Lucy Juliano
Revised 07/15/2014 My Commission FF 031228 y� vy Commission FF 031228
CWIV Expkes0813012017 _ _ ?pfpd Fxpires0513=017
REVIEWS FRONT ZONING SUPERVISOR PLA*NSI VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REV E R EW
DATE
COMPLETE �Z�llOOLt
INITIALS ,,Zi