HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: d�� �5 Permit Number:
r_
REQ IYE-D LUG 21 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. IL/
PERMIT APPLICATION FOR: b
Address: &D P/Ice n,5. Rb(, FT: P e r rto
Legal Description:
Property Tax I D#: a 31 a- y t'1 y — Q d O 1 O CA S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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h e Lo r.6:n r,r-P_Te To h a 2 O o-6 jR S,Ti1
—1k tj + re M e ,S Cis C'�-,e 1 e- T O b e- r n. •h. C�`
Additional work to .e performed un er t is permit-c ec a t at app y:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric. _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: . 1 3 o Sq. Ft.of First Floor:
Cost of Construction:$ l 9O 6 .ov Utilities: —Sewer _Septic Building Height:
Name F h O {' Name: 11 r- n ,4-2
Address: Y,, A Company:,gLL.-AYne1w•ieo,- OXil-g-, -f ?eanad'fe
City: State: Address: 16 ,5 , S',� . �er S�o�e J-2
Zip Code: 'Jy�y1 Fax: City: pg i-w i s • L u e ; e Stater
Phone No. -Ila 5-7 q_(p q ll Zip Code: #,S-'J- Fax:
E-Mail: Phone No. `7 Z- 3 S`j — '75 4 7
Fill in fee simple Title Holder on next page(if different E-Mail: `
from the Owner listed above) State or County License:C RC C
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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#o-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 rpaying 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.
Signature of Own Agent/Lessee Signature of Contr or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF k . L x c t-R
The forgoing instr Ment was acknowledged before me The forgoing instrument was acknowledged before me
this 2-1 day of 2015 by thi^ day of 20 k5 by .
Q Z-d,.to S-r o LZ S 1 1� d o Vie. Za v S A-G
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pubk--State of Florida) (Signature of Notary Publ'16-State of Florida)
Personally Known OR Produced Identification Personally Known oows
Type of Identification Produced L Type of Identificastate of or
NNA GIVENS o ' � Comm.Expires Dec
f.N, Ftonda ;:E My #EE 858761
Commission No. ) 16 Commission No. �� _ - ,{ In
` TRY PUB�iNssn
otary PubExpires Dec 16•�� C� Thr`ough National Notary A
�� v1 Gomm EE 858761 ^ '••.,�OF r� Bonded
REVIEWS 1=R0 EZCyyIVING SUPERVISOR PLANS VEGETATION SEA TURTLE ' MANGROVE
C�OUNTR "" REVIEW REVIEW REVIEW REVIEW, REVIEW REVIEW
v;i•
DATE
RECEIVED
DATE
COMPLETED
-Re—v-.7/2014