HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE
EEjINFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,
Date: / �� ' l,a ' Permit Number:
RECEIVED
Building Permit Application JUL 15 2015
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 V
PERMIT APPLICATION FOR:
PROPOSED 6NPROUEMENT LOCA l�N•
Address: 30&-7 (1,kar(zS [ FL 3MI&
Legal Description: I t�c6d r b vis OtA C"V% krt IoL x 64 S /&fc1d F
Property Tax ID#: (CI 2 ?5' D o 2— —0d 0 �?—0o o Lot No.
Site Plan Name: p Block No.
Project Name: 8&zA . f ALep
Setbacks Front. Back:IS Right Side: 7, S Left Side: 7,S.
DETAILED DE�S'CR�GPTlON OF WORK;
. 5 3000
iLr'
-d CG_ vL)c-10vACIClQ�
CONSTRUCTION INFORMATION:
itiona wor -to a pe Orme under this permit—check all that app T.
_Mechanical _Gas Tank _Gas Piping _.Shutters _Windows/Doors
Electric _Plumbing _Sprinklers .:Generator _Roof
Total Sq`. Ft of Construction: `q6V Sq. Ft.`;of First Floor:
Cost of Construction:$��oo, d D Utilities: Sewer:. Septic Building Height:
NOR NER/IN"1SEE: COMORNAMC011
Name L&,Lxra U Name: zy_
Address:_ 30107 cl/ w fe'S 1,J7 . Company: C_ Can
City: rod AerC e— State:E Address: �/ r
Zip Code: ��C1 �(9 Fax: City: 5/ 6G6e— State:FL
Phone No. 77,"Y6 5 -2333 Zip Code: 3' 1 517 Fax:
E-Mail: Phone No 77
Fill in fee simple Title Holder on next page (if different E-Mail ���', Cove 6_P_+0_' IN 5
from the Owner listed above) State or County License 29Y
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPP'LEMEN ALCONST�r Cl1 LIENLAW 1091 RN NTIONl:
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 our Notice of Commencement.
Signatu of Owner/Lessee/Agent Signature of ontractor/License Holder
STATE OF FLOR STATE F FLORID — i
COUNTY OF / i COUNTY OF
N
The forging instr was acknowledged re me The f rgoing ins as acknowledg d be
this day of 20� } this day o 20 J b m
�era.� LU
W v
1,4
(Name of person acknowledging) W (Name of person acknowledging)
W m ��CESYG%!J :ri
F
(Signature f otary Public-State bf Florid (Signature of tary Public-State of Florida )
PersonallyKnown OR Produced Idenr jet' Personally Kn• wnOR Produced Identification
Type of Ic ntifi t' n /� Type of Identific
ion �C
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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