HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SC N tV Permit Number:BY
St. Lucip, rn,
RECEIVED
Building Permit Applicatift 3 0 2015
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 _z_ Residential
PERMITt APPLICATION FOR:
PROPOSED INPROUEMENT LOCATION:
Address: 2`;,t R MavnInJ dR ,L
Legal Description: otrt -e-r R e-ef &1~0e1 (1 !1 f-1— 1 o3
PropertyTaxlD#: ) L42,10 lo(qN 6r)a3 vivo rl Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
_Mechanical _Gas Tank
'Electric _ Plumbing
Total Sq: Ft of Construction:
uo
Co'stof Construction: $ 3 S-6
Gas Piping
_ Sprinklers
_ Shutters
_ Generator
Sq. Ft., of Firsvi'loor: _
Windows/Doors
Roof
utilities: Sewer,. _Septic Building Height:
OWNER/LESSEE:
GONTRACTOR:
IJaM6,7 ir4 w,rs 9e6x,-T- WucKe,-
Name: M'tG641, �riv tcSy
Address: 4914' 5W Ld, IGe. 6 v-? 4 na I
Company: D_rFra„ �rsto ine
City:_; NiL" e f y State: F L
Zip Code: 3 4QtIV Fax:
Phone No.
Address:-8B-4,) onr Some
91 me Trc,i�
City: ft
Zip Code: 3414 5� Fax: 772-
Phone No -77'1- 462�- 2ol ^ -7 lei
State:
L/ 65 '7 973
7
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 4 r Fran taws •C t 0 c &
,r aL • eo
State or County License ►z f; 241)n
36a
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION
LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: 000I4- 4�4 aJ MvgtJ 4",F4
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: Bob; .7pLa'war c
Av4
Address:
City: f-![: Pt-uizc
Zip: 3. ip Phone -772-
State: r- L-
Q60 7751,
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,.] 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 vour Notice of Commencement.
-�h,'J2 n .
�^,,bao //� rz_ �
Sig�ure of Owner/ Lessee/Agent
Signa of re of Contractor/License Holder
STATE OF FLORIDA
�
STATE OF FLORIDA t
COUNTY OF •
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 'day of 7 20 /�by
thisday of 1 20by
��m hr
(Name of peyon acknowledging)
<°
(Name of perso cknowledging )
i,.
�
Lm
C
iti
(Signature of Notary Public- State of Florida)
Agw h
(Signature of Notary Public- State of Florida)
Be Be m'
✓
Personally Known OR Produced [den t
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ia�
Personally Knowny OR Produced Identificat
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Type of Identification
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Type of Identification
Produced
L„
Produced
5w $
Commission No. (Seal)
r�4
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
M
.
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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