HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q �// /,j
Date: Y �7 /_,�� Permit Number: `� 6• o4y
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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:
PROPOSED lNPROUEMENMEMO T11,
Address: LPI LA l3Gc.dn/!� I/� i/i (2 00lIVC-, 6(ci6�_ 3WYi
Legal Description:
Property Tax ID#: 3''� a� d 1�a- (366- O Lot No. 16P67
Site Plan Name: AIIA Block No.
Project Name: i�Cf l�csvF
Setbacks Front Back: Right Side: Left Side:
DETALLED DESCRIPTION O WORK:
2 oFF -1'�57��/G ��//• G 6S 2G 19L/q-C OJ D ("n ewso"V qZ_
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C®NSTI TION INF®RMATION:
Additional work toTe_P__e_ff6r_med under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 67) / Utilities: —Sewer —Septic Building Height:
OVVNERjLE�SSEE: CONTRACTOR:
Name 4LLGsitl q)(1 L ko D Name: _I e/g/y /2 z�Ve 12-
Address:
Address: Gg 6-c6 'Sv, Company:Cd u N 7�% ' .�ditl5% clC %�o/V LCC
City: pg-l- S-r Lcce/6. State:9 �' Address:
Zip Code:-(/95-2 ,Fax-:7 IIJIA- City: 'L/fC�/�D��G� State:(
Phone No. `51)- 9`T��^ /.���� Zip Code: Jay q 741 Fax: y&7��s1
E-Mail: AIM- Phone No 77� - Z/6 L/
Fill in fee simple Title Holder on next page (if different E-Mail /
from the Owner listed above) State or_6wnty License CCC
Evalue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S,IJPPLEMENT'AL CONSTRl1CTI,0N LIEN LAW IN�FORMAl'I�ON:
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.
Signat 6o1
Owner/Lessee/Agent Signa ure f Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S )i- . L'o r-% Z COUNTY OF S . L Jc
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this'Zl day of q 20_�5 by thisal day of 20_V5 by
75
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu 'c-State of Florida ) (Signature of Notary Pu ic-State of Florida)
Personally Known OR Produced Ide PSI Personally Known OR Produced IdentificgUo
Type of �g J rr
Produced Identification DEpNN�S�a1'ep�y6'ZDT�, Produced p-, �p GIVENte o Florida
r'JRob£ 1a �eT Notary Po lig icesDec 16.ZQ�6
oda m xP' � Y PU''4
Commission No. C C`.-.tory� `'D�a��al�.pTJ Commission No. 85876PS
sn.:
`_,; :o � �hrnu9h� " ". . 'oc Commi u h Nacional Notary
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stn o� 6onaa y�"Te F`OP.` BOndedZh(
REVIEWS FRON i:���
ZONING SUPERVISOR PLANS VEGETA SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.