HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5'1 �� Permit Number:
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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:
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Address: 9411 511SICK OA Y-_Dr
Legal Description: 1(\CAiC Ll \_V_i Ver E-JtV.-heS— un',+4lo"BI—K''aa— Lo+s W ay-icL 31
( t JCJQ 294 /11 N)(OR DMIF3--19. DIN- 1�1F)IS1 ; 35_qG- IQg5)
PropertyTaxlD#: -Q,— GO-1 � M'Sa-- Goo —1 Lot No.30431
Site Plan Name: Block No.
Project Name: Utt?C� Mo rW-eS
Setbacks Front Back: Right Side: Left Side:
fast u 1 i ke Co/ like a cr z door -
AdditionalOman
wor to ne pe Orme under -this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping —Shutters ✓Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$�a�o� Utilities: _Sewer =Septic Building Height:
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Name_ W 501'C MOrC01t5 Name: C eQf4e. Shoe)
Address: E5L+l 1 SI hear Doo L DI' Company: 'MM En�c'.fnrise of &(nW dh4
City: For-1'-pIeXCci State:FL Address: 1108 "Torr,ahgrJlr Di
Zip Code: 34OIV. Fax: t4I A City: Iden State:
Phone No. NIA Zip Code: 32837 Fax: 32-1- 777- L123
E-Mail: Phone No. 772-337-21,170
Fill in fee simple Title Holder on next page(if different E-Mail: bu. ess aun &ho.0. c W1A
from the Owner listed above) State or County License:
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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:
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 your Notice of Commencement.
Signaltu0d-f OvAerlA
0 - gent-i Lessee Signature of qqkractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF trews
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this -3 day of A ee;1 20 )5 by this d3 day of_ fPvt 1 20 15 by
Geo"-Qr Shan 6eorg2 54.aw
(Name of per gon acknowledging) (Name of person"acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida
Personally Known v1 OR Produced Identification Personally Known Y/- OR Produced Identification
Type of Identification Produced Type of Identification Prodqee&--�------
6 SHAUNNA LUTES
SHAUNNA UJ W
My G
htiyc"pul'. CN#EE14C303
Commission No. (Sedl')
EXPIRES:Nuwmber 14,2015 ZN#EE146303 Commission No.
�4 - I EXPI§ lwamber 14,2015
Public UndORIOM Bonded Thru Notzy Public UndeRroritars
Uui,,dod Thfu Notary Public UndoRwRM
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014