HomeMy WebLinkAboutBuilding Permit Application -All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED U
Date: `t Ism Permit Number: Wi
RECEIVED APR 2 2 IN
Building Permit Application
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:
A gga 4 - sa
Address• / � �� �� IT � �l y
Legal Description:
PropertyTaxlD#: a3 ��-� ���p �C� S�i 03 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front 7 C Back: Right Side: Left Side:
91,1 N
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PON W4
44 69P ( lAre rle,c,14 l� 64&` � e v;
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Additional work to be pe orme under
un er t is permit—c ec a that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft•of, onstruction: Lt�x Sq. Ft.of Fi St oor:
Cost of Con'struc
tion-
Cost a ,�P� Utilities: _Sewe`r' :_'Sd'% Building Height:
st>.r s$'A'�—s� t
. L^ §i` Z' ' __
Name ' -!l!MA, 6 balto Name: re q
Address: 2—tfS ] T u Company: ®irC�f��:.^r4 ! ft� �•
City: Acr«- ' State:_ Address:
Zip Code: 39Fax: City: V �� = Stater
Phone No. Zip Code: ?) 6160 Fax:
E-Mail: Phone No. 24-2--
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) State or County License: te�`LC"z
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER ENGINEER: Not Applicable
/ — PP 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: 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 our Notice of Commencement.
Signatur of wner/Agent/Lessee' Signature of/contractor/License Holder
STATE OF FLORJDA STATE OF FLORIDA
COUNTY OF COUNTY OF' 1-.Oz% -sl
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledg%before me
this aL4.day of q 2 C"\ 2015 by this'JLaday of 0 p J- 20_ by
- Vic--) C.\a'n �aAP �y%- C% v., PQ�eekY..g �
(Name of person acknowledging) (Name of person ackn ledging)
(Signature of NotaryPu ' -State of Flo \o�tsa 6 (Signature of Notary Pub ic-State of ENS �iaa
NPG\ ,e 6 2�1 DO"Sate o�Fio 20 6
Personally Known O �l.l � ifan . Personally Known R Pro 9d tjffci�
Type of Identification Pr ed ` ES wp` •° " Type of Identifi o��,•t�r"` EI PCIA � Fti8 pss°
1P
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No �`� X00 �0a� _z. • .'s MY miss i�130
Commission N '�, a°m ��e,�l rY Commission No.
REVIEWS FZONING SUPERVISOR PLANS VEGETATION_ SEA TURTLE MANGROVE
CO TER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
-Re-v—. 7/2014