HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: Y.
RECEOVED
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 APPLICATION FOR:
-DripPROUE-MENMEN 0
Building Permit Applicatiglq 3 0 2015
SCANNED
BY
St. Lucie Cnl,nr�
Commercial Residential
Address: 7-%iq :rcmA
rrnd 91- Fr-
rP"4-`'
(-C-
Legal Description: _6u4- e
r Roe F P ovi JA
urhrT Za 1
Property Tax ID #: ) t4 3 t. Go q O00 4 tood i-( Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left.Side:
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
M
r tnis permit -checK all tnat apply:
Gas Piping -=,Shutters,
_Sprinklers _Generator
Sq. Ft. of First Floor:
Utilities:- Sewer J Septic
Windows/Doors
Roof
Building Height:
OWNER LLESSEE:
CONTRACTOR:
Name )e21.trT Wu[VeY
Name: yhr(_" 7dicranMSza
Address: �qqN .Sin) I -ore. ",t
Company:�)i!Frah(rSio
ZGt(
City: QatLth7 C 9a-V State: irU-
Zip Code: SY q40 Fax:
Phone No.
Address:'3$ 40 )_o- e S50^e
Prue Tn_%L_
City: ET ( -e rc -e
Zip Code: _� 4 g 4 '�_
Phone No —472 20j —77
State: r L
Fax: 772 t/l• 7873
97
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail A ' fra n ean5 a , n
e @ d o ( , Z'o 1-�
State or County License V, 9 Q40a 36A 1
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONST UGTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: - _
Name: t tonK 4- rrltr%c..-el, Wvrl
Not Applicable
.i a ecl vn
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: gob t a4 ut- t4y.r--t
Address:
�,
City: F-� T—sr-c I
Zip: 3ygq--Phone �!77,
Stater
L6c) 7-7Sf
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY: _Not Applicable
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 your Notiae ^f C Mmencement. r
ire
rl
^qj
-m, i&
� _.tI
Signature of Owner/ Lessee/Agent
®z
Sigrfatuf6 of Contractor/License Holder
STATE OF FLORIDA
r :s'
STATE OF FLORIDA . dr 4.
COUNTY OF
;
COUNTYOF Lt eyq
The forgoing instrument was acknowledged be
nS
The forgoing inst(u�ment was acknowledged befo
YW �
a rare
this day of 20/S by
: yl
this day of r I740 72L 1-- , 20 /Sby _.
_?LU
1C-� Ae
mI(_*P6 _ r-V""CM i All
(Name of person acknowledging)
(Name of person acknowledging)
(Signature cy,otary Public- State of Pforida)V
I�
(Signature of No a Public- State of Florid ) U
/
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
i
Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014