HomeMy WebLinkAboutBuilding Permit Application .c
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: f OSI
- - ---- Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 4
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click here
,F,-r'"' r �ia`•.,r,;: rr, �5^ rN„ - aki ,+.;':
�'L'1;.
.:il..
Legal Description: QeViyy,.,5ir All ygs 5- &1/AT AZ Z (D 277 ,4 C)
Property Tax ID#:3Y/:5'7Dbl 'cyo�2 —Ooc7 —o Lot No. 1,57
Site Plan Name: Block No.
Project Name: 92/ e/�ir�
Setbacks Front Back: Right Side: Left Side:
,bmoiNNIS
MEN"
:r
r
;.'*,.... '
r
A/C CHANGE OUT EXACT REPLACEMENT
itiona wor to e�n`je orme un ert is permit o-e6ec,c a appy:
HVAC I�Gas Tank ❑Gas Piping _Shutters a Windows/Doors
aElectric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: 186 S . Ft.of First Floor:
Cost of Construction:$ 50 Utilities: Sewer Septic Building Height:
rr .� � �^3T �A,yyl. x �$l.«"� NINE.
� s: ��7
u FlN h j 'P �Sf3 ,yy}s ,.))4`+� t`16. !l� T�{ i�`FsS h0.nyk
eC^`�.,7:h'�:.tW. ✓. t�:73Ya�IsCl`�3'�.'a'�t"Gt.`.u7,33.'f,«}?sY.'.�sa�.6 f ^�.' 'ati' -
Name Mr Name: MARK A VINES
Address: 7.2e 01 Company: AZTIL
City: 100- . AWL(G4cS State:FL Address: 2540 S MILITARY TRAIL
Zip Code: 199,5) Fax::/, City: WEST PALM BEACH State:FL
Phone No. �77.j 607— ;2(/g/ Zip Code: 33415 Fax: 561-434-0018
E-Mail: Phone No._561-433-2197
Fill in fee simple Title Holder on next page(if different E-Mai &ZA417a41AG":Ct X
from the Owner listed above) State or County License: CAC049253
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
y hJPY +�j r ^,.3•�„'-'�.r}�I"- -rY'.�•' ���+{!i�n at'�L�*�`���kr�y}�r"�,E�9� ����'� F�,�J.,e�xv��p,YJ-��h,4',y,".. , ,9-�,?�, y.,,� y�.,�sca s �y :..xr���') .fs .-,�Y:
���+�,�t E'�/fi� T��L C�1 Y�t�t/��Fl•t"J'��,,,J,�! jG,g.� :, ViV`�IJtY.��`, �,,�fl•�`A'w"• r1+i > � -r..��"�J`'� ' � f -=`� �h�`;� .
DESIGNER/E�1GIAlEER: _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:
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 oermit 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 rem r in Noti of Commencement.
Signature of OlfwnerlAgent/Lessee Signature of ontractor/License Holder
STATE OF FLORIDATATE OF FLORIDA
COUNTY OF f'� COUNTY OF P�'�sEacHcouNrr
The forgoing instrument was acknowled ed before me The forgoing instrument was acknowledged before me
.this day of 'dGR ao 20 / by this o�z day of ,��i"L' 20Q by
(Name of perso c nowledging) (Name of p n ack owledging
(Signa re Notary Public-S` a iorida) (Signa a Notary Public-State~da)
Persona P nally WPE@A�Iglp�
Type of dant' at 1�ii1°� Type of Ide t�fitaN4441SPIrAl 9F=
N�
o;
' Flo?.° EXPIRES December 17,2017 ••.'BOF oP.•- EXPIRES Decemb r 17, 017
Commis ion'4�o: Seal) Commissio {� �(Seal
(407)398- ryServic�.com WB7) NotarySenlice.co
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED