HomeMy WebLinkAboutBuilding Permit Application 07/15/15 12:30PM Aaam'o A:L= COYicllt ZLmg, XM0. 772-878-3951 p.01
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `� `, ��
� V vc
Date: -A Permit Number: ec
CEIVED
Building Permit Application JUL 15 2095
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
S�^ M r.{carry +k y4fY. INS SG4} 1 4 �' j} RT*Le }'1'F`{!N
.. �1 ?:�nvM1l � 4<w, 4r) ,�.'�i"�v,2+sv+Arr v++' z •ts
NO _ :b -,. 4P aF<'!rn �,'N
k }. r M� Fw ?� Le1ws
Address: a '
Legal Description:�Y"Z"�`l('iL ei �f C� ���� i ► E �('l� 3--
04� ( -fir
Property Tax ID#: 11�� c-� t �(� �" Lot No.
Site Plan Name: Block No.
Project Name: k0jAni CA LA
Setbacks Front Back: Right Side: Left Side:
.� i.XSS.An..� J_"'%L@,
..B V,4Y'ti31 * 4
4 w s ! t wA a. rw L s k ! Kxt 1 KwW :'
? A°' t., S
W- 1 .� t''.I�i` 6a .Na! iF3'�}
s :i.: •..�1 ,i. t.xu.�„.fii! .ran ,§;..,'�sl '. 1 W'.W l-..'r/a�kL�.•,1'!m
(Lo .
� �i� } y � Y:ct t@;;�2 hjv� ;s�.<hn.,���ar-.crt.�•,r�,��151,;�,'�Y:.rS.Y"gaC�tsax.+;is� 'y�;&+Y. X .4�� YT.cpru� ,ten ��. ,iid�'Dr��,it'gi#
v .. NO
f ' tiY,i^ a lar` k'K t,U( "aiY'x?LSs.ka'H" S.f�aA� ,,e .+f, e '•th .,raxae#
It10n} tj Or tOl @ e "o htF "F a . y w 1 i 4S *� f r
;�,r. «.:..a�•k1 r s ,r„z.l.:"n..•.,on
..... t :awKD ''�'.. .�,r,.
VAC 1rme under this permit-c ec a appy:
"Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric El Plumbing Sprinklers F]Generator Roof
Total Sq.Ft of Construction: �--2 Sq-Ft.of First Floor:
Cost of Construction:$ Q Utilities Sewer[]Septic Building Height:
- r.: ,.: u•..e ayttN r �T4 xyr rr� 4 + r mnC,tmr.. <
lr.1.Y.} 1
+
4bS
•:Y'. .ts»ty���v?5 ���..p'f"Gi1•.1,'�}?»i-v;M'" .';��,y.�; i4 ter"* '� � ..�Y.rl',�lSi{l":?S:;xr �a�':s .Yt � t, u���� a°+r.,d 4,
Name Name: f-ciQ,
Address: Company:
AdftCity: State:15, Address: �,x�z}�`N W
Zip Code: Fax: City: k3ia►t 3t. I.t Ll.,l l._34986'i State:
Phone No. 12-2 S� Zip Code: Fax:
E-Mail: Phone No( � 6,62S_�n
Fill in fee simple Title Holder on next page(if different E-Mail.(-\\ • 1�ifi f''��J
from the Owner listed above) State or County License: �'f
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
^_ 07/_15/15 12:30PM AU.— A1z Condi ti o-:Lmgr 2nc. ']72—B']8-3951 p.02
u
2
J
.. e� , ,y d
a'
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:;
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address: i
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie Counter makes no representation that is granting a permit will authorize the permit holder to build the subject strugture
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,lfrote to obtain financing,consult with lender or an attorney before
commencingwork or `din "our Notice of mencement.
Si atu of Owner/Agent/Lessee Sig tC Aqr'Lic der
TE OF FLORIDA ` ATE OF FLORID
COUNTY OF art • Ll A e'a COUNTY OF � , Ll A C�i�--
The for�pQ�', instrument was acknowledged before me The for 'r g instrument was acknowledged before me
this t7 ay of 20 14 by this (�day of 2014 by
r)66 a foi
(N—J&of person ackno a ing) (Name of person acknowledging)
LL&A7VK0-A
i�
r
(Signature of Notary Public-State of Florida ( ign ture of Notary Public/-State of Florida)
Personally Known OR Produced Identification V"" Personally KnownV___
OR Produced Identification
Type of Identification Produced (_... Type of Identification Produced
Commission No. (S Karen RoesWmmission No. ICww Roeiuvw
NOTARY PLJpUC NOTARY
A
Comm#FF133193 Comtrt#FF1331
Revised 07/15/2014 E-Wms 8/1642018 Exp&MG/11610 8
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS