HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE
//INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n
Date: Y 15 Permit Number:
RECEI1'-D SEP 0 4'201
Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click here
PROPOSED Irn.IQRO%vi�-c.nrYArI:vNr:LOCATIrO.
Address: 61 (A
P + t ("y
Lc I i7esCrIN�i-n: 1 rL+..Je• \(� V a V [l i b- VcKa (b 4q
Property Tax ID#: � �t "� �J�-C` co Lot No.
Site Pian Name: Block No. e
Project Name:
Setbacks Front Back: Right Side: Left Side:
pE`I-eILEU DhSfR1PTII<)`' F;VinRK
i r
CONSTRUCTION INFORMATIOW
Additional work to tiajrtormed under this permit cheCK allpa appy:
Ll
L�IHV,",C Cas Tank Cas Pipi;g _Shutters �V:�;ndu,.'s;Doa:s
Electric FlPlumbing Sprinklers Generator F]Roof
Total Sq.Ft of Construction: S .Ft.or First Fnloor:
`
Cast of Construction:$ ,eb bo Utilities: Sewer LJ Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name ,1 Name: ue,I - ani
Addie s:NO �i- entirfola Y��cv Company:
City:_ t)Ck �' Wet' State-. Address: � -� �.
tr .
Zip Code:._.. `tJr_ ___..._. Fax: City: . t .tC:�CE: -_ State:
Phone No. -
.._-__-......___._.�__.�......�_._._.-.. �___....._.__--._ __._
-1 Z-- `b`1 '' 1C� Zip Code:3� 8 Fax:
E-Mail: Phone No. 7*7a- L65-1(oo(v
Fill in fee simple Title Holder on next page(if different E-Mail. Q61UQrdn"!)0,f-t I r(S 11D�1?'!Q i f IYI
from the Owner listed above) State or County License: . 03%&Q
t- --- x+87
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIciYvERJENGINOE'i: _Not Appiicabie MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address: +_
l.11 SSta e: Cl y. JIG IV.
y'
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: s4 _v Not Applicable BONDING COMPANY: —Not Applicable
Name: Name:
Address: Address:
City: City:
iZip: Zip: rilGiie:
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.
,.era:1.- f tc.a granting, f thi:-e^. ted ria. 'i v h F agrae �^
�t:..v..3:.A...G:i:J:i�: ._granting,ip.7. .....,iLLS......i....l:ii G,I..C�l i�G:G'.:y ub.C.,t:IC�.'t l
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 attomey before
iomili2iidri work,of recording your Notice of Corm-nei`icenient.
t ature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORII A
COUNTY OF�,�_ COUNTY OF -. '` at ti71---�L[f_r_ -----
The f oing instr men was acknowled ed before me The forggoing instr ment was acknowledged before me
thisV day of 20�by this I day of 20_Wby
��a' Mvel
� �f�Ll '1 ilfYh�Z11 U'i'l
(Name of person acknowledging) �- (Name of person acknowledging)
42
111H11lffl ��
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(Signature of Notary Ff ( ignature of Nota uric-Stlt ,
`�Q0;�ypIRESa�e0/d i
Personally Known :—A%Pr C"ification Personally Known Of ��' ip4 ntifice,�ti �
Type of Identificatio &-d 1 o ate;atl Type of Identification Produce�u,^;y> a ti
a�f: C
Commission No. �B :'� r;:=' mak Commission No. ( ,a:
/gll1lllf 1 t tliloSia�\\
Revised 07/15/2014
REVIEWS FRONT ZON!NG SUPERVISOR PL ANS VEGETATION SEA T'.1R T LE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVEDJ _.-'_--
DATE
COMPLETED