HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 15 d �a`13a
RECEIVE0 APR`2 3 2015
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: To Select from dropbox, click arrow at the end of line
Address: d vATi ju L eA 6 t-A/
Legal Description: 5A V Arva,is C Lu/0 - P(_,9 7' 'Two
Property Tax ID#: 34a:S- -70 a- 0 00- Lot No. orb
Site Plan Name: Block No. ,�
Project Name:
Setbacks Front Back: Right Side: Left Side:
Elm:
1111A C_ "r 1Ce. . zoo r� f -3- 9-76–LA.) S,6,'t�L
Z_e.v.v0)e
Additional Work to e orme un ert �s permit-c ec a app
' eHVAC �.Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
11Electric F�Plumbing ❑Sprinklers Generator Roof
Total Sq.Ft of Construction: S Ft_of First Floor,
Cost of Construction:$ 339 0 Utilities:Sewer[]Septic Building Height:
Name S N i 2 l c I4-O L MZ_5 _ Name: e)�R
Address: 30S74. S,,4o i 1.@w f 4-W - Company: r_*L fAA1 Are. '7Ec H Ivo Loi ins
City:P IZ St LLI C-r4 State:,E� Address: /S--,791 A)MA14k9X C104--
Zip Code: Fax:Fax: City:1 A�,T.S� Luc►c State.
�-
Phone No.c•{oi - 'ZSR - b7 Zip Code: ff lysz_ Fax: n35= /8d2_
E-Mail: PhoneNo. - 6
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: CAC-o 51666
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
6ti6-J £000/3000d 9ti£-1 -WOad 9£=9L 9LI_£Z-ti0
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: -- City. -- - -- - -
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced•prior to the issuance of a permit.
5t. Lucie County makes no representation that is granting a permit will authorize thepermit holder to build the subject structure
which is in conflict With any applicable Home Owners Association rules,bylaws or antl 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.
s
u e of Owner/Lessee/Agent SiAM Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Syr Lu c Ig ce)j &1+1 COUNTY OF 5f Luau-E Cbo p� �
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this Z 3 day of Agit.., 20 15by this K3 day of 6 pQi L .20 1;5— by
(Name//off person acknowledging) (Name of'person acknowledging)
(Signature of Notary:70"R
tate of Florida) (Signature of Notary Public-State of Florida)
Personally Known Produced Identification Personally Known
Type of Identificati Type of Identificatici"'6 SANDRA WACrs`E�
i�'"Y'-. � SANDRA WALSH E*�
§ MYCpMMISSIGN;!`FFg91i18 .
Commission No. r f yCOMi i'ON*FFaa1113 Commission No. 3.' EXPIR�2d);iril 11.20118
y:.• ��
EXPIFIES April 11.201$ (407)398-0153 Fter1ftNC" seivrmcam
(4r71394�153 m i
Revised.07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
M—d £000/£000d 9ti£-1 —WOU 9£=91, 91, £Z—ti0