HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
U 3 l 15 Permit Number: ISO A _43 d 1Cp
T
V G RECEI . :D AUG 0 3 101
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:
PRL3,POS:ED.I,N�PRcQVEME�NT,L®CATI!Q .�,t
Address: 6�4� l 7�'1c�'tirr i?:yCt [ i�•�erce Fl- 329,'2-
Legal Description: oortCr2le ak,ke G✓hy G✓a/i Gra
3000 (sI C,b« rusti q,'^cn,_5
Property TaxID#: 3y la- \a3-��a �roa� -q Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
row
D ryTAhLE® DE�SCRI!PTION�O• WORK: ;: , , xT
� h 'J•`/iClus ;by /2oa� pai 1/ be 12-x')2
�kc4&s
CQN�STRLIC
litN I'N�FOR+M�ATI'®N: �
itional work to be pe orme un er t is permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters . _Windows/Doors.`
_Electric _Plumbing —Sprinklers _Generator _Roof
Total Sq. Ft of Construction: fi'yO0 Sq. Ft. of First Floor:
Cost of Construction: $ Z,SOO Utilities: Sewer _Septic Building Height:
QUVNER/LESSEE: CDNTRACT®R; Kam
Name *oge khn Name:
Address: c�y01 S �irdi'.yq /2ivc/ 17�►s✓� Company: COVe Caacreft ex/te/
City: v - rd"•C'2 State: Fl- Address: 14Wh �Q
Zip Code: ftz Fax: /V City: I/elo 6e,,c4 State: FL
Phone No. ft• X32 e5r1 f Zip Code: ?Z�'d T Fax:
E-Mail: �//� Phone No 7 72- •
Fill in fee simple Title ,Holder on next page ( if different E-Mail oeyeCa"c''e/c'a, j5X4c,,•/. Caves
from the Owner listed above) State or County License C9C f 331027
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
MT, ►LCONSTRU"CT(ON LI N LAW INFORMATION:
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.
w
Sign re of Owner/Lessee/Agent Signa a of Contractor/License Holder
STATE OF FLORID STATE OF FLOR)DA
COUNTYOF 5 Lvc�� COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 'J day of 20k5 by this 3 day of a`1 q 12o,5 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu c-State of Florida) (Signature of Notary Public-.State of Florida)
Personally Known OR Produced Ide , '2� Personally Known OR Produced Identification
Type of Identification ��* "r,,,,'"l of"'' `. Type of Identification
Produced �- L ' - �` C\c•s�a�e V6'26. Produced L..D.L
c PubE 1s95
NNAGIVENS
Commission No. _ P ,�'s Ml G° 1}°�#�o�N°�atY PSS Commission No. ,, DEA S6�1 of Florida
Nolary pu61id c 16.2016
o% 9p°dedZh�pU.�`� '°•`�•w°.?My Gomm.ExPn#DE 858761
mal
NOW I
REVIEWS FRON ZONING SUPERVISOR PLANS VEGETftp ;;� S R-TEC' kMANGROVE
COUNTER REVIEW REVIEW REVIEW REVI REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
lev.7/2014