HomeMy WebLinkAboutBuilding Permit Application - r
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' l Permit Number:
EGEIVEC'
Building Permit Application MAY' 14 2015
Planning and Development Services
Building and Code Regulation Division
2,300 Virginia Avenue,Fort Pierce Ft 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Re idential__-X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: Y b-t- Q:.tr —
Legal Description: 'Peer l l Cres?l� i Pa 7n _0+
O 3- t �3
Property Tax IDR: 0099--coa- Lot No. _
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Elm,n„ 1 k'.dl,r ...
q+nerVajt 5 1brt IW 5c% ' A,.1kL_ot-di*1ot'e_4Z Ynot)Pi_- PP- Itp(DOA3 INN aye-iP, e4.1A Llek -6 To(J
mad�t tz'R I v (OVA 4 \1r%r b4? 5Q-CeA " tn11-rI-t id Ku) __t PC-I-r t \-AS-W-
Additionavw6FIZ to be ve ormed unde is permit-check all appy:
MV
iAJHVAC Cas Tank Gas PipingShutters Wir s Doors
Electric Plumbing F] _Sprinkiers Generator Roof
Total Sq.Ft of Construction: , y S . Ft.of First Floor:
Cost of Construction:$S� c . 00 Utilities:t lSewer QSeptic Building Height:
r, Atw
Name �F 1CcCJ••, 4- Ren-CL ))Of- ,a r-, Name: U» I dem
Address: q'1 `} p� hr asr Company: Y e �tOt�1 .YV!
City:_ pti` , �.tI(;t 2 - State: - Address: tp '� St ' ►�� prtC E
Zip Code:.�dt,1RLp Fax: city: } F_ State: q,
Phone No. 'Rog- 13 - ,Ll3q zip Code: ` 3 Fax:V'A- 6"_ ?;5Iti
E-Mail• m aid `
�.� S�-i � ca o I, Co,r� Phone No. 71A-6'11-1,510d
Fill in fee simple Title Holder an next page(if different E-Mail• CSC Sr? an-oil .
from the Owner listed above) State or County License: ) IA3
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required. !
57',8:a6ed 2bb929b22.L:01 ab )433dS;=J.� 2T:80 S102-bT-NJW
Wo
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPAN _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone-
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: i 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.
i
St.Lucie County makes no representstion that igranting a permit will authorize the permit hol er to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenant i that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any res rictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all resr ects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendr ients.
The following building permit applications are exempt from undergoing a full concurrency revie :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 o3uslbe recorded and potted on the jobsite
b first inspecti ya intend to obtain financing consult ith lender or an attorney before
c mmencin workarr—recording vbur Notice of CommenceRent.
s
_Signature of Owner/Lessee/Agent Signature of Contractor/Licer se Holde
STATE OF FLO DA STATE OF FLORIDA
COUNTY OF Y-- COUNTY OF
The f�,rgoing instrument was acknowledged b ore me The forgoing instrument was cknowledged before me
this, `� day of 20y this 1Z day ofQ0 f y by
(Name of person acknowledging) (Name of person acknowledg ng)
atGt���n „:Y .,
=( At�ttSiubhe_State of Florida) ( Ignature of Notary Public tate of Florida) ^�,?''F :_7-- a
x
to iy-Kno�vn:•�'- -OR-Produced Identification Personally Known O Produc�d,IdenjCatldn.
T .e if-L6tlrrWtrdd0bd-' Type of Identification Produced J Q-"
Bp)CHAR al) Commission No.
F�' �F•` "MQMNBSSIpN#FF125528
LINDA MAR E BOUCHARQI 51A48
MY COMMIS ION#FF 255* '�ye�` '"�'
iNary$Crvtce"com �. ?�
_ :?a EXPIRES ay 2Z,gp18 "1.7r• a
} -t?791 :.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TIURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
j
C,C:a6ed 2bb929t7aL•0f Did A033cIS:w0.a-�1 t7T:eo ST02-t7T-),tJW