HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1� .
Date: -I Permit Number: rJd� O 1 y
RECE1 TD JUL 2 9 2015
- - _ Building Permit Application
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:
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�P CSED 1 FA OYEME I LQ Aril'
Address: LMS_ �M X TA\JJ _7A-!5 AV� Pc-PLC—" `1--C.. 9 LAet q(c
Legal Description: 0&SFA_AA6Mir -�E(r-2jfj. ,,1tVbtil -ELK 4 C_ . aE L 1'S 17 AJAp (3
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Property Tax ID#: 19_3 1 701 110q& 0mg Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator X Roof
Total Sq. Ft of Construction: �zq8 D Sq. Ft.of First Floor:
Cost of Construction:$ gL{gr7•CV Utilities: _Sewer _Septic Building Height: j S
: � - 4 .
01NNER/LESSE k � kCONTRAC`FOR -�� f �F
! ,�- ,-14 x-
Name_ _WANDA ,STa)F-t-jS Name: US--5r ns6-J
Address: i{!50!5L (0,,*-LAi l' ,_ 6 Ayr- Company: 6&&8,4 ta&k (Sim
City: State:'OL, Address: 3Z`71 61�ti4r�D�-7L}k'V
Zip Code: Fax: City: �' y'rl�(� State:�L
Phone No. `7,7-2 Lf-115-3414 Zip Code: _�?EiCi 9.2_ Fax: -777-
E-Mail:
tZE-Mail: Phone No �'�z - 21.►� -8I7
Fill in fee simple Title Holder on next page(if different E-Mail /
from the Owner listed above) State or County License CCCSSS
OY73/ it)ZS`),
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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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:
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 applicEAble 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 alPrespects,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 tinrice for
improvementFork
ur property. A Notice of Commencement must be recorded and posted on the jobsite
before the firection. if you intend to obtain financing, consult with lender or an attorney before
commenci rcling your Noticeof Commencement.
Si nature of Owner essee/Agent re of Contra or icense older
STATE OF FLORIDA- STATE OF FLORIDA
COUNTY OF s$. 'L-,3 COUNTY OF -S
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of �LILy ,205 by this&day of 3 20 IS by
eJyye C qS--d wb V4
(Name of person acknowledging) (Name of person acknowledging)
O �
(Signature of Notary Pu 'c-State of Florida) (Signature of Notary Pub&-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identifica .g
Type of Identification ype of Identification GIVENS
Produced rr t.b t— oduced L''Q1— taf publicA
��`�yy APV i,�� State of Flori a
�C p GIVENS a ;2+�*°= MoComm.Expires Dec 16.2WE
G �� Seal DEPNN Siate of Ftorr ` rssion#EE 858761
Commission No. C6 mission No. c�
"u„, r) Public' Dec 16,2 ��°a IT�hrough National Notary P s
.OPµY PUg,c NotCo m Egplr#EE 858j6 ssn. ��''%°�M„`` Bonded
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REVIEWS FRONT NG gond d OR PLANS; VEGETATION SEA TURTLE MANGROVE
COUNTER 12 \Y REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014