HomeMy WebLinkAboutBUILDING PERMIT APPLICATION=I
ALL APPLICABLE INFO MUST BE COMPLETED FOR
Date., 16 / �'F- 1 r
8 Lode Moon
RECEI ED OCT 192015
Building Permit Application
BE ACCEPTED
Permit Number:
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' IMPROVEMENT. LOCATION
Address: .�� `�i G'4 3 V
Legal Description: i'?"L 65 15 L_ A N 0 N C. R core D- S i C l i o -J
P ly K C. % L 581 (1 N D ptz,3 " Cow+ w+ o .!
Property Tax ID #: Lf 50 2_ - 5 0 1- 0 0 a 6- Lot No.
Site Plan Name: Block No.
Project Name: C=0 ,u t-n' c: Z- S i ti c t-C >= w Y+•+ 1 L
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
5
U P-►S v C 'i o R. Y . ffv W- e_
CONSTRUCTION INFORMATION j
itiona wor o e e orme un er t is permit - c ec a apply:
VHVAC 13 Gas Tank ❑Ga Piping _ Shutters lLl Windows/Doors
® Electric IM Plumbing �Sp inklers Generator � Roof
Total Sq. Ft of Construction: i i S . Ft. of First Floor: 3 8
Cost of Construction: $ P &X�. I Utilities: Sewer F-1 Septic Building Height:
.OWNER/LESSEE r"
CONTRACTOR.
Name jz iC IA Am r> 'F. y2 iNy
Name: 9 1 CI{ i12D r=, I%nvoz. az.it -f
Address: 12-40 "A, gvsai975s P)<J i'L,
Company: 5 NoMC- L/AJ Mncs1L.6 I+ow44r
City: C- tis S N St�te• `F- t ,
Address:
i
Zip Code: 3 Lf g S -7 Fax: 3 '3 `i
City: ye NS c "J State: 1= z .
Phone No. - 7 'Z - 3 3 14 - '-I 3 3 4
Zip Code: 3 `I 5 S -7 Fax: -t 1- 4 3 3S
E-Mail: (2, != M 1 1 ® A e t.. , 1c40
Phone No. �7 '7 -?_- 3 3 Y- q 3 3 &(
Fill in fee simple Title Holder on next page ( if different
E-Mail: , F M q a t S c> 1) o L . C-cs v^
from the Owner listed above)
State or County License: �P: c d 5''7 2. G ?L
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN -LAW INFORMATION:.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: 5 fJALutJ sr Rm C3Av&14
Name:
Address: 3ov pve oir co A7w Pro r-j s
Address:
City: PVAL-m G A czpt-- s State: P �
Zip: 3 y w p, Phone: S6 i- 2c •- - (..qt q 1
City: / State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not A plicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: / I
City:
Zip: Phone:
Zip: !/Phone:
I
I certify that no work or installation has commenced pr
St. Lucie County makes no representation that is grantir
which is in conflict with any applicable Home Owners A:
structure. Please consult with your Home Owners Assoc
In consideration of the granting of this requested permi
in accordance with the approved plans, the Florida Builc
The following building permit applications are exempt fi
accessory structures, swimming pools, fences, walls, sig
WARNING TO OWNER: Your failure to Record a
improvements to your property. A Notice of G
before the first inspection. If you intend to obt
commencine work or recordine vour Notice of
_ Signature of Owner/ Lessee/Agent
STATE OF FLORIDA
COUNTY OF S)v • \. V � t -91
The forgoing instrument was acknowledg defore me
this%' day of Q� <-Ir 20 !- by
rA
(Name of person acknowledging)
(Signature of Notary Public- State
Personally Known OR
Type of Identification Producei
�b es
Commission No. C.�S��
i s , •., N �om� ss�°� 0
01
Revised 07/15/2014
to the issuance of a permit.
a permit will authorize the permit holder to build the subject structure
Dciation rules, bylaws or and covenants that may restrict or prohibit such
ition and review your deed for any restrictions which may apply.
I do hereby agree that I will, in all respects, perform the work
ig Codes and St. Lucie County Amendments.
m undergoing a full concurrency review: room additions,
screen rooms and accessory uses to another non-residential use
lotice of Commencement may result in your paying twice for
nmencement must be recorded and posted on the jobsite
in financing, consult with lender or an attorney before
:ommencement.
s
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTYOF S� . LUcoe
The forgoing instrument'was acknowledged before me
this i;:; day of 20 L by
R %clna A f f qy
(Name of person acknowledging)
(Signature of Notary4bublic- State of Florida
`vENS E�Oad �6
Personally Known Ft0 P=r Rc�@�tiR��tigrDi _
Type of Identification P ced
`Zommission
b u9�rq�
REVIEWS
FRONT
ZONING
SUPERVISOR
f
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REV),EW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS