HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: T7 61 15- Permit Number:
7-' = RECER'-D AUG 141015
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 V
Phone:(772)462-1553 Fax: (772)462-1578 Commercial /� Residential
PERMIT APPLICATION FOR: Window/door
PROPOSED IMPROVEMENT LOCATION:
Address: 1M00 6 ®Ciel DR-
Legal Description: ocaqpc '5a MA COt1D-)1'.&)�) 1% i �(� IT 1006j (J��Ql�
�l �11�)�
Property Tax ID#:_ 4511'517- OI 03 '-OIO -� Lot No. Al
Site Plan Name: /JDA- Block No.
Project Name: ff_RAf4Pt -5C' JTA4 TE
Setbacks Front Back: Right Side: Left Side:
DETAILED DESC-RIPTION"OF WORK:
(z'RT ED PF—OCUCTS
CONSTRUCTION INFORMATION:
Additional work toe e orme under t —checkispermit a appy:
HVAC []Gas Tank Gas Piping _Shutters Windows/Doors
Electric ❑Plumbing Sprinklers M Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ $� Utilities:n Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name LD0E-.ITPe Mr-NiAhAt Name: ZOy 'TOi-I'ks-rbi14
Address: i0(v00 S. (DCkAIA .DIZ1Vt__ Company: -_�TVP,izr 1'A.tw- 6L)PPW
City: TE)"LSF—N SE H State: FL_ Address:_ 'PC> F50X It 7 7
Zip Code: :54957 Fax: 14 1A- City: �N6E-N 5FACA State:
Phone No 703-q23'(c 7�5 Zip Code: 345 1� Fax: 77Z -334-Z765-
E-Mail: Phone No. 7`7z - 334-i2.7®0
Fill in fee simple Title Ho der on next page(if different E-Mail: n1`�T(�rq("ke_ boi IAC'r5_`itc ,7�1
from the Owner listed above) State or County License: cec is 17g4(n)
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN ,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:
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, consu ender-o an attorney before
commencing work or recording our Notice of C mmenceme
G s
ignature of Owner/Lessee/Agent Si ture of Contractor/License Holder
STATE OF FLORIDA / � �/� STATE OF FLORIDA
COUNTY OF �-� QIAi� COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument Nas acknowledged before me
this � day of `y 20/-by this ay of 20 15' by
C?-" Pcq4 M t4ca
(Name of person acknowledging) (Name person acknowledging)
(91'griaturg of Notary Public-State of Florida) (Si natu a of Notary Public-State of Florida)
Personally Known V OR Produced Identification Personally Known � ,p�roclg�Igi !tiStitciPitil
Type of Identification Produced Type of Identification u o Jac ueline A Pascarello
u4 9¢IMyCommission EE104667Commission N (BS& Commission No. reso ! 15
ry Public Sta oridaVV
r° Jacqueline A Pascarello
c fission EE104667
..q�'�0 p�0� Expires 08!22!2015
Revised 07/
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS