HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 2
Date: / �1 ' /y Permit Number:
a, :
•' RECENED
Building Permit Application SEP 1 2015
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
PROPOSED IMPROVEMENT LOCATION: -
Address: 9Qy(o S• 06C"4 b0,W 003 Je171A 13et1'/
K
IQ /
Legal Description: K1 ,aMlal2 V1 1! ✓�1i x003
Property Tax ID#: 4.,5r0 Z e J03_ V eo YV_05V, Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: L Left Side:
-DETAILED DESCRIPTION'OF WORK:
�; g r r�3 ,� o6op, zl4 Aver , �., �l
Q CS1S� ,' ��st}� S7Slt oH' wi�� S peci4 I e n�Yjy foi�tv�,4jl.m g a>> ra C oi-• Lc>s
fa C Lc,> 461 L0.2.5,
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit-check all appy:
❑HVAC Gas Tank Gas Pi in _Shutters 2Windows/Doors11 pg
Electric 0 Plumbing Sprinklers ❑Generator Roof
Totals cl. Ft of Construction: 379 S . Ft.of First Floor:
Cost of Construction:$.22j i70 Oo, Utilities:Sewer Septic Building Height:
OSNNER%LESSEE::
CORITRACTOR.' : N:
Name 1,40012 Lf
Name: & • i) !/
Address: 0 '6u.4 . Company: /�
City: - o/k State: /Jq Address: ! !(
Zip Code: 2 �O _Fax: City: 0 leg h Stater
Phone No. Zip Code: S or 2 Fax: ��- 9i!O-1aPA
E-Mail: Phone No. 30S-- 592- VOL
Fill in fee simple Title Holder on next page(if different E-Mail: .,AlAin
from the Owner listed above) State or County License: G G t✓ O 2
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERJENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: KAMNAIS jfnQ14 1±t Name:
Address: : JAddress:
City: 0 I State: City: State:
Zip: Phone: Zip: Ph ne:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Ph e: 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, 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
�9-"1 - 0 X , s
er
_Signature of O nLessee/Agent Signat e o o or License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST �_ v c t `L' C iy COUNTY OF M t 1 D E Q eC
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this nay ofP�j c— �� 20(S this tb-yday of . K-J 6JS C 20 1 S by
1 0 tJ K\ oJ
(Name of person acknowledgin ) (Name of person acknowledging)
(Signature of Notary ublic-St to of Florida) (Signature of ary Public- tate of Florida)
Personally Known OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Iden=*FEXPIRES:
1 S L- ,c ' vSG Type of Identi s ro uce
ELIZABETH EZ-C NO MY COMMISSION 0 EE
CommissionItEEB � Commission N 16 3ai )
w 16,201601`
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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