HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INNFFlO1 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / '� V /S Permit Number: 167 7 01=1/_-2 ,D
RECEIVED
MEMO
Building Permit Application JUL 2 0 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 Y
PERMIT APPLICATION FOR: To Select from dropbox, click here
PROPOSED INPROv TXD ONMNiTION.
Address: 7SD V 4e,-:�r,So rea I�`e✓
Legal Description: LgZe. cpoo.-lPo-le uh;f 7 &k 73 /d 7�►�'i� � /�/Daerr �ras2S-�l- 2Z
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Property Tax ID#: (,301 — 402 40 ,fe—o0 O — 0 Lot No.
Site Plan Name: Block No.
Project Name: cin eol__
Setbacks Front Back: Right Side: Left Side:
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CO:NSTRUCTlONINF�ORMA�TION � �", 4a
itiona wor to e e orme un er t is permit—c ec a appy:
HVAC- _Gas Tank E]Gas Piping L2§Shutters ❑Windows/Doors
❑.Electric. ❑ Plumbing ❑Sprinklers 1-1 Generator ❑ Roof
Total Sq. Ft of.;Construction: SFt.of First Floor:
Cost of Construction:$ 0�.3 6 Utilities: _Sewer Septic Building Height:
OWNER/LESSEE Aix ' y x
y4J1 n CONTRACTOR
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Name igez C54 0 ale Name: l,.S 1/01'6
Address: SD O de o Company: C0°✓ 1. cs .. r✓f el 19 Awp
City: State:Z3/ Address: V G i G
Zip Code: �3V! J/ Fax: City: A
Phone No. &136 7 Zip Code:,I qg Fax: 77#2'yG�
E-Mail: Phone No. 72., '4WO' 1
Fill in fee simple Title Holder on next page(if different E-Mail: 7 0 P4, V )G (2 YW o. GOrh
from the Owner listed above) State or County License: S-cG/J//�I Sod
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CQNSTRUCTI(3N LIEN IAW�INEORMATION.. . :.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address: 4 1'44
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 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: roomadditions,
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.
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Si nature of Owner/Agent/Lessee �;;q„+;,,•••` • 'gna ure of Contrac License H6119i
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STATE OF FLORIDA ' m� STATE OF FLOR
COUNTY OF ”" COUNTY OF
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The for ing inst ent was acknowlecied before m 4i go= TheAoring ins t was acknowledged befor
thiday of o 20/ by sT hiday o 20Z�Ibyc0
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(Name of person acknowledging) ame of person acknowledging) �6 o
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(Signature of N ryPublic—State of Flor da) (Signature f o ary Public-State of F orida) N�
Personally Known OR Produced Identification Personally Known �OR Produced Identificat N
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
.Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED -
DATE
COMPLETED