HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �t u
Date: `1 v5 Permit Number:
RECEIVED JUL.2 9 206
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: To Select from dropbox, click here }}J csC
PROPOSEDi"lN'PROVEMENT'LOCATIO;N':
Address: SDSS' A/. �i� X606
Legal Description: Z&Wlf (/� V_ OWla_ZS /JP.tr��h/6 C/fv��' !W
Con 10/6 - F29 1119-670)
Property Tax ID#:' /5z^1 w 6c1 —C9136? — 000 Lot No.
Site Plan Name: Block No.
Project Name: C.4kX7611.4s"
Setbacks Front Back: Right Side: Left Side:
1'*PETAILEUb8CRIPTIO.Ns 0E WOR1<�
A/C CHANGE OUT EXACT REPLACEMENT 3 Zo_i/ — 10,414136--,WJ ,V,4
nt5,Rz�lT/llul.�1
CONSTRUGT�OiV'INFORMATION,
ittona wor to b
( rtormed under tis~permit-cnec<'all appy:
HVAC L_J Gas Tank ❑Gas Piping _Shutters F]Windows/Doors
Electric 0 Plumbing Sprinklers 1:1 Generator E] Roof
Total Sq. Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ OC70 Utilities: Sewer El Septic Building Height:
:OWN ER/L)=SS:EE: COIVTRA'Cl'O.R:
Name /Cn9'a-r�iZ� /y 12�C�i/�9.5� Name: MARKAVINES
Address: S05'r l!� /-�l",oQ t�liZ,�J C r6�6 Company: AZTIL
City: State:FL Address: 2540 S MILITARY TRAIL
Zip Code: 3X9W9 Fax: J City: WEST PALM BEACH State:FL
Phone No. 677a)205- SWe -- Zip Code: 33415 Fax: 561-434-0018
E-Mail: Phone No. 561-433-2197
Fill in fee simple Title Holder on next page(if different E-Mail: SAMPOLIT01@GMAIL.COM
from the Owner listed above) State or,County License: CAC049253
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
'STR -71OWL ENt--�,..A.W'.,'-.-,!;NF-G'RMAT-1
'MCG
F.L -N b CT 1:
DESIGNER/ENGINEER: Not Applicable I 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 your Notice of Commencement.
Signature�Owner/AgWi—i-Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OFPALM BEACH COUNW
The forgoing linstru t as acknowledged before me The forgoing instrume1it was acknowledged before me
this Pf day of 20-0 by this Pff day of ')y 20[Mby
IL
(Name of person ackn led (Name of person acknowledging)
01,96at a ublic-State of Florida) (Sign ure otary Public-State of Florida
Per nal K wn OR Produced Identifl;ic :' n 7TPersonally Known OR Produced Identification
e I ntification Produc -Tyiu of Iden
y
........... I
,-;A JOHN EDWARD GIF ORD
JOHN EDWARD GIF ORD I I
Commission No. rrCC
• N'40MMISSION#FFO?7W mission I*;- hiiyr-nwissio 97427
EXPIRES December 17, 017
EXPIRES December 17,2017
FlurldaNalarVtse ice.com
Revised 07/15/2014
REVIEWS - FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED