HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFOMUSTMUST BE COivurLETED FOR APPLICATION TO BE ACCEPTED r ^�
Date: Z61' % - I� Permit Number: �J �D- Uc`--2
SCANNED
• BY RECEIVED
Buirdih"009 h ApplicatiQ(�n
Planning and Development Services "CT 19 2015
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:
Legal Description: -Aw AW5-;k ,4eR-d--5 ®` A°'I- ;;L-9-
Property Tax ID #
Site Plan Name:
Project Name:
03 -jaz - 00,E - 000-3 Lot No.
r Block No.
0044Ar 2 3
r
Setbacks Front 17 D Back: Right Side: Left Side:
&01) ivrcy Gdre.a2-Aa7/t 7a 442&A- D� Scar I3�11
_Mechanical _Gas Tank _Gas Piping _Shutters
Electric _Plumbing _Sprinklers Generator
Total Sq. Ft of Construction: 15-1d Sq. Ft. of First Floor:
Cost of Construction: $ l//j Utilities: —Sewer _Septic
Windows/Doors
Roof
Building Height:
UtNER%LESSEE
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Name` . C9. •"-
<Company: � IZ.I a'
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' Address;"°3.SG � -�s�W� Rim •<
City: f7 /0!/ �'
State L „��c,gr9ss:
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City: s
State:�r'i
Zip Code: 3 `f9K% Fax:
Phone No. 77,�,-- `fG - qr% 6
Zip Code: �2ci7 Fa
Phone No -
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E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail Z.t - 5^yh6.
Gtl
State or County License. l� D
56� �(� �•
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required: s .
.E EN:.'L G SRUGTJ N LjEf�j W INFO,ER
TON: �.
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone: -
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
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 vour Notice of Commencement-
Sigfiature of O. ner/ Lessee/Agent
Sin ure ofliractor ense Holder ,
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S+. LI,{Llf
COUNTY OF — L U C I `'G
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 19 day of lkUQ,(A%+ 20 1 S by
thisA*'Nay of K}6(� 20�7 by
(Name of person acknowledging)
(Name of person acknowledging)
k
(§igWati.fre of Notally Public- State of Florida)
(SIgaliture of Notary Public- State of -Florida )
Personally Known �_ OR Produced Identification
Personally Known OR Produced Identification i
Type of Identification
Identification
Produced ,.•'o'" ``s''• GINA RAFTER
Produ dAll II
2 Notary Public -State
Commission No. F 6�°I =% `lpy Comm. Expires Ma
�'•''i
C I Florida .•'•%,. GINA RAFTER
fCaRl Sion No. F� la o U°ISPg yPublic - State 01 F
„ Commission N FF 120098
:s My omm. Expires May 6
'
Comnissmn a FF 120
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE`
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kiev. //L014