HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE`INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C\I ``T� 5 Permit Number: I YJ O S
RECEIV -D SEP 112015
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: To Select from dropbox, click arrow at the end of line V `
PROPOSED IMPROVEMENT LOCATION:
Address: 7625 Lt 1,Q-Q L-V)
Legal Description: Re,seeve l C U Ao
Property Tax ID#: 3 3 ' -`r Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
NY\0-�V\ \WV Q. 0VV-J k)-Sc b%bb Mile,
o�� �Xi S c� II'�� uVXdeR dal
o,S�c� M-eC4 ck n Caxp p
he) 1 i At --keate
CONSTRUCTION INFORMATION:
Additional work to be nerformed under tis permit-check all apply:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ / 50 Utilities:0 Sewer ElSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name !C- tQ .SQ Name: 90mm Nn(-Y1
Address: 133h0/ 5\,)j 91 Company: 1,
City: �Q�11 Stater Address: ag`7 Nw GIZ
Zip Code: Fax: City: ?0?--V S+ 6f- State: L
Phone No. -�O 15 - 510--670 Zip Code: 8G Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: eVZJDQky
from the Owner listed above) State or County License: CTK 0•2go g9
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 thepermit 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.
s
_Signature o Owner/LesseAgent Signature of Contracto License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF 1pmotleel
The forgoing instru ent was acknowledged before me The forgoing instrument vyas agkn�owledged before me
this day of 20 6 by this_Ls day of >� CJC.G 20 �� by
(Name of perso c owledging) (Name of pers now ledging)
(Signat of y Pub[' State of orida) (Sign of of PublI State of FI da)
Personally Known d/ OR Produced Identification Personally Known j// OR Produced Identification
Type of Identification Produced Type of Identification Produced
e°°°Q°, pY g�Ufa V Galabova
Commission No. (Seal) Commission No. .�.•••.,eG, t ��
eee°"PgYp�j°r°°►�arganta V,Galabova �a• ���COMMISSION#EE 837077
COMMISSION, 9'•- :e` EXPIRES: SEP,20 2016
wwW.AARONNOTARY.com
EXPIRES: SEP.20,2016
Revised 07/15/2014 ° ,�;;;; � VYWW AARONNOTARY.com
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS