HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �
Date: ll/ ' 45- Permit Number: '� � `
Building Permit Application RECEIVE®
Planning and Development Services JUN .1 9 .2015
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL.3498.2
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: 44-1 L La kz' V o to A
Legal Description: ,la_-_ V o,a o �'�A �ta o t'_;LAT%M a
PropertyTaxlD#: ���� ���i�C311aO�C�OoYt;, Lot No- zby
Site Plan Name: Block No.
Project Name'
Setbacks Front Back: Right Side: Left Side:
14\J A C_ Ltik6 ''Foe lco_ 1a a.> 1 S+cc tZ N A18X
-rtiona work o fI—rrorme
under tispermit-checka appy:
I VIHVAC Gas Tank ❑Gas Piping _Shutters []Windows/Doors
Electric 0 Plumbing Sprinklers Generator FIRoof
Total Sq.Ft of Construction: S . Ft.of First Floor:
ee �(
Cost of Construction:$ 'S 9�o Utilities: _Sewer LJ Septic Building Height: _
Name I FroP,2, C.L A Az Name:Z E FIF RLv�A-pIV,�A
Address: 1161"1l L.4' la Vt5 t,1 rt.�ta Company: Clea,, -►2 . .1C)4tJe{:tzc'i��s
City:i>oc7%- ;St L_x3c.kG State: Ft- Address: tS'1$ UICIriEkLR Ciwc%Q
Zip Code:-,%4-1q S z Fax: City:�fl4T s-r Lv«C State'
Phone No. S_NJ . 4t ct-I Zip Code: S S Z Fax: : S- 7 gd Z.
E-Mail: Phone No- � ! - ?_,O 61
Fill in fee simple Title Holder on next page(if different E-Mail: Ct-PA cl !5 h i , o4d/_- co l'-�
from the Owner listed above) State'or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
6L0-d 8000/3000d 068-1 -wodi 80=ZL SLI-U-90
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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:
certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting apermit will authorize thepermit 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 roams 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 Notice of Commencement.
s
_Sign wner/Lessee/Agent 5 o actor/License Holder
STATE OF FLOFEDASTATE OF FLORIDA
COUNTYOF T Lett �'i�ti► COUNTYOF aT L-Lw-16 Gave.
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged efore me
this 18 dayofMmgr 20 _6by thisig day of VA)Z 20 1., by
zli (ZS C- N LA ��C C F\LAF_�PA
(Name of person acknowledging) (Name of person acknowledging)
igna ure of Notary Public-State of•Florida) (Signature of Notary Public-State of Florida)
Personally Known tI/OR Produced identification Personally Known ✓ OR Produced Identification
Type of Identificati f, Type of Identification Produced
;¢';."•,yEA awry
Commission No. ski "= MYCOMf I9N#FF091118 Commission No. ' �, SAN )WALSH
=,►i +-
EXPIRES April 11,2011$ a MY COMMISSIONFppA111
:• � J\ ri111 2078
Revised 07/15/2014 foal))$ei53 F1�ridAKata servlce.c�m
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
6L0-A £000/£000d 06£-1 -W08J 80:Z L 9 L 6 L-90