HomeMy WebLinkAboutBUILDING PERMIT APPLICATION-All APPLICABLE INFO MUST BE COMPLEI`
Date: 2�Im �15
FOR APPLICATION TO BE ACCEPTED
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number: � tS )3�
RECEIVED FEB 1.12015
Building Permit Application SCANNED
BY
St. Lucie Count%
Commercial ✓ Residential
Address: lvv /V,. f'10C.0 I/KcI 1'
Legal Description: 54. Uui�e 6L,"+�/ ,API
Property TaxlD#: 02.-3I I - %./0 - 00oo 000- 6 Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
nitionai worK to De perrormea unaerinis per�ms-cnec
_Mechanical _ Gas Tank ,/Gas Piping
Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ /, 00 0
_ Shutters
Generator
Sq. Ft. of First Floor:
Block No.
Windows/Doors
Roof
Utilities: _Sewer _Septic Building Height:
Name P. Li c ^e Co-4 V
Address: .2300 Av-e.
City: FIL, f e� e, y State: )
Zip Code: 3'1'A 2!2- 5632 Fax:
Phone No. (77 L) cf62. - 3" I k2
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: C.A—S Joknsv^
Company: (fd� Zs Ak Su--,
Address: 3t2 AJf $opCt-, C;,r-c e,
city: /,SL Stater
Zip Code: 3`kt %5 Fax:
Phone No( 77 7� 9-0 1 - 36 i 3
E-Mail:
State or County License: 28C1 d6
If vvhta of mnctrnetinn is 95nn nr mnre. a RECORDED Notice of Commencement is
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:
co:
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 bylaws
rules, 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, sighs, 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 Not' of Cominmencement must be recorded and posted on the jo It
before the first inspection. If you int o obtafinancing, consult with nder or an attorney bef e
commencing work or recording o otce of Commencement.
SiglTature of Owner/ Agent/ Lessee
S' o Contractor/License Hold
STATE OF FLORR,,IDA
COUNTY 5%• LNX
STATE OF FLORIDA
�,
OF
COUNTY OF tI•
The forgoing instrument was acknowledged before me
The forgoing instrumegqt was acknowledged before me
this k% dayof T-00 20'VS by
this "day of lrr • 2015 by
cy,5;1sils1m�Mr Sob -v, C> n
C1nr� 0P�aar Sohv.ban
(Name of person acknowledging)
(Name of person acknowledging )
(Signature of Notary Pub c-State
(Signature of Notary Pu Iic-State of Florida )
:0fFlorida
GNENS �\oi`da
Personally Known OR i�eggtPfiPaFiRW'
Personally Known g ation
Type of Identification P ed n soe0 16
Type of Identifi i „roduced 1 State of FI°
C°m ion °a�
Commission No. 4-. "•.'�n �y �0mm`��y 'C`°
�o �= omm.ExPiresD 587F,
Commission No. ommisSion(S I
ia%Vonal °tag
•
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ZONING
SUPERVISOR
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VEGETATION
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MANGROVE
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DATE
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