HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABV INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� Permit Number:
0
res .
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 N Residential
PERMIT APPLICATION FOR: Vl'lec.,h oLr\,'� (
PROPOSED LIVIPROVEMENTLOCATION -
ti
n
Address: ,gyp py-1Y V( V`�ii� L� �1VA Ki-t�� k k c-ie'
Legal Description:PIuz►- P(rk -LCf"LJ q-elk.�q 344 (t6
Property Tax ID#: �IC1 11 II Jo a 2 tq bC Lot No.
Site Plan Name: C�, `1 2—DHJJ Block No.
Project Name: 0-1 "`27 i
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION ;OF WORK
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Repkzce- 1- ko-- D- P1KO\e-- vkr\-�-� UA Iejch 1c� Ne 2-+-\-o n C_- c
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U- kkk OW L� i8 �L� ��--r !? Gin l ; S i (� ((-
CONSTRUCThON'�I N FORMATION
Additi . a wor to e e orme under tis permit-c ec a appy:
HVAC E] Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric ❑ Plumbing Sprinklers Generator 1:1 Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ l,� p, � Utilities: SewerSeptic Building Height:
O -PdER/LESSEE CONTRACTOR
'd
Name F- 10y L_,C_C- Name:
Address % Y- 03& c-2 �F Company: ce Iko,(Aawao
Citi' p,+� - -)�. _�Vt�t �4��t+ State _ �r Address•
Zip Code: ,y'� _ Fax: City CI, ^, U State*
Phone No.`1 a � C� Zip Code: ` i // Fax: �-- ? (p(Q 71
E-Mail- (J Z15. ( I Phone Nn
Fill in fee simple Title Holder on next page(if different E-Mail: J^ [.f!J L�i1?lI %c,Lh. (zv7
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
AUG/20/2015/THU 01 :54 PM P. 0,02
M1.
DESIGNER/ENGINEER: _ of Applicable MORTGAGE COMPANY: _ of Applicable
Name: Name:
Address: Address:
City: State: - City:
_ _ —State:
Zip-, Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER; _Not Applicable BONDING COMPANY: of Applicable
Name:MCstZI82ap► Name:
Addy, C� (, c� 0SJ 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,l 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 fi insp ion.If you intend to obtain financing,consult wit der or an attorney before
' r or
commen ecordingxcrur Notice of Commencement.
s
gn wner/Lessee/Agent Signatu r se Holder
F FLO A E OF RIDA
TY OF UN F V C
The Ing instr ent was a nowledg fore me The rr�Qing instr ent was ac owledg Before me
this day of ZOUy this, of V 20 by
(Na fr rson ac nowle gi (Name of person ack owledging)
(Signature of otary P��Zduced
of Florida) (Signature o otary Publjc- Florida)
Personally Known identification Personally Known 1// OR Produced Identification
Type of Identification Produced Type of Identification Produced
lL�.. j /-"
Commission No. ' evo l (Sof) Commission No.G ff)2_ (Seal)
15717
RI,S ;.••, r.;ro laiSPOLi
*T * My COMMISSION 8 EF 118%9
t sqr En . �uNlemher84,3Q15
9ondedFh
Revised 07/15/ 6F�� NBudyelNofarySorvices aOFF,c�O Ban¢es►Thw6udgetNotarySellrCes
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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