HomeMy WebLinkAboutBuilding Permit Application W
ALL APPLICABLE INFO MUST BE COFWTED FOR APPLICATION TO BE ACCEPTE I _!
Date: (p /S �' ' Permit Number: P�n
' RECE��$
Building Permit Application JUNE*15 2015
ED
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34952
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential ►✓
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED1MP,ROVEMENT, LOCATION
Address:l3to CQHPM1VJfALT6( CoVQY +-o2-r 'P(Ttul= 1--L -i I4`t'
Legal Description: L-6'1' K f3t_ock r"+ OF 0C_nf0srx)VF VfJAT 1
Property Tax lD#:M 414 -10 1 • o 1's i - oo b -3 Lot No.
Site Plan Name: Block No.
Project Name:V0 f-Grp-S COVE,
Setbacks Front Back: Right Side: Left Side:
DETAILED`DESCRI!RTI ON OF,. RK '
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F iRVA FR o IA'E COWMS OF K005E TOiF(4 0 H TE(t< K09C :N
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CONSTRUCTION INFORIVIATIO;N
. �
Additional work to be nertormed unclert is permit-check all appy:
HVAC Gas Tank F—Gas PipingShutters Windows/Doors
OCGenerator
Electric Plumbing Sprinklers Roof
Total Sq. Ft of Construction: �_ (�3,5' r F Sq. Ft.of First Floor:
Cost of Construction:$ ? c(c�s, o o Utilities:USewer[]Septic Building Height:
OW N E R/LESS,EE CO
NTRACTOR:
Name MARC "N Liy A Name:
Address: l3tc a o,mmo t4y•Ltf( L-1- Company:
City: Fb ZT f"r&LLf_ State: P L Address:
Zip Code: 3`HI J Fax:"•r T 2- - 4ib .Q, City: State:
Phone No. J-12- 24(o- -137 5 -7 -o 5r7-7 Zip Code: Fax:
E-Mail: C-e.M&J !20 nt(•i_jDVA Phone No.
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
PST LO. 6 .
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable
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 thatnowork or.installation=has commenced.0ridr'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 our tice of Commencement.
cS_ignature o er/Lessee gent Signature of Contractor License Holder
STATE OF FLORIDA STATE OF FLORIDA
--COUNTY-OF— _�-�C c� COUNT`fOF --
-The forgoing instrument was acknowledgetifiefore me The forgoing instrument was acknowledged before me
this�l day of 5V vie __,20_11D by this day of 20_ by
le.
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- tate of Florida) (Signature of Notary Public-State of Florida)
Persona Ily-Known. OR Produced I S�00Qi,O I; Personally Known OR Produced Identification
Type of Identification p�CP���• SOe �g6� Pse Type of Identification
Produced L L ��1Q���yo`�e �C� No�at� Produced
Commission No. L `;`•.�`y( �a���o°Qr + Commission No. (Seal)
r o_ (�
:E OF.
REVIEWS FRONT ING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014