HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5 \S Permit Number: Sd 5'd 5
o t = RECEIVED MAY 2 9`1015
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 --1 —
PERMIT APPLICATION FOR: To Select from dropbox, click here \ d I
PROPOSED fNPROVEMENT LOCATIddON:
Address: I3-35. UE 1,05 tc. LVb
Legal Description:
Property Tax ID#: �,�Qo�- �d 1"' 1 6�a- CQQ-3 Lot No.
Site Plan Name: Block No.
Project Name: I33S f\J�Tr1-�s 'FLS
Setbacks Front Back: Right Side: Left Side:
DETAILED DES;CRfPTION-OF.WORK
; .
M PO9,R ' POLE, �-o Cod 9;RdC�r�o��J —/i s eeh eW Iti,
CONSTRUCTION INFORMATION:
Additional work to benertormed under this permit-check all appy:
HVAC nGas Tank Gas Pi _ n Windows
— � in Piping Shutters Doors l� /
2 Electric 0 Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: 1100 Sq. Ft.of First Floor:
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Cost of Construction:$ -5-00 00
USewerFISeptic Building Height:
OWNER/LESS'E'E:' CONTRACTOR:
Name S W KL-F-`i ISOPDICK Name: pmyol-� 6LWI1/11 hV
Address: 336.5-6 sE81T 1111AJ LJJ bpz' Company: .Acw � _,t n17m Ake
City: !TrF_P 1fJG f{E(GKlS State:L Address: 7300 (;ollo7f P1_
ZipCode: City: A2T -s-r L xte State: FL- /
Phone No. 7a— aUZip Code: 3495a Fax: 771-$"
� 7�s'-r.�•S`1
E-Mail: IZy l� ��lyl Phone No. 7701- 370
Fill in fee simple Title Holder on next page(if different E-Mail: %�CVrN'Cf/ �' A-T, "ET
from the Owner listed above) State or County License: Ocoee 307,?,
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION-
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 thg first inspection. If you intend to obtain financing, consult with lender or an attorney before
comme n wor r recording our Notice of Comm encemen .
Signa re of O er/Agent/Lessee Sign ture of Con ctor/License Holder
STATE OF FL /
STATE OF COUNTY OF ORIDAt�Gc z- COUNTY OF ORIDA J �
The fo ing instr ent was acknowledged before me The forgoing instru!�.ent was acknowledged before me
this day of 20M by this-4 day of �i20�by
Gr�
ac
(Name of person ac owledging) (Name of rson ac owledging)
O- -ye C / r
(Signature of Notary Pub c-State of Florida) (Signature of Notary PuNUNblic-S 'te of Florida)
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C.
Personally Know OR Produceyt�:� Personally Known OR Produce��tc� l�h6y��_
Type of Identification Produced- rdO �jBr?�Ns % Type of Identification Produced \���� O� v�9�+!�i�_
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Commission No.ff-OVS-l9d *(C aI Commission No.FFD 19A
Dorise C. Virg!lio #FFM,9z 'lio "Z �'� �cn:
%� . �� C. �O.
�,p'�aryPobfioUn� � t i 2 •��
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