HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ['
Date: J Permit Number: /J O.a3zff
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: TTT�
PROk,P(3SED !!NPR4UE ENq' LfJGATIC•1
Address: �o I -D I ON ,-1-1 +Y-'C--4
Legal Description:
Property Tax ID#: bQ LQ , 0 DS`4 C)D 0 �"I Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DET AILED D@8-0RI�PT12N =_K'
CO STRl1CT!®N lNFORMATlON: MEN 111�
Additional work to rmed unde this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric 4 Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ )oo .00 Utilities: _Sewer Septic Building Height:
OW ER/LESSEE: C®NTR T
Name ZD;...r ,t_' /:c7rr I Name:
Addresses�C �i7e cr; r1 I Co J�cYs arc
City: 2 L -State: ��dress: ( . a.. S
ZipCode:3ggq5 Fax: y: I ev e. State:
Phone No.11 a- � L tl-)` L I Zip Code: 3 q J 152— Fax(IZ)O S R 141
E-Mail:4A�bl^n,,,5-Pe-e.0 A(�)L ,(,U► Phone No (172- 1 LUCA. Qleo _
Fill in fee simple Title Holder on next page (if different E-Mail c--&X cl�Sni 4 ..nom
from the Owner listed above) State or County License (°'FG 4 tLZ S1 S�(
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRU�CTI'ON h EN`LAW IN�FQRMATfiO
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.
Signa T
r of Owner/Lessee/Agent Signature of Contractor/License H Ider
STATE OF FLOR A STATE OF FLORIDA
COUNTY OF e� � \� COUNTY OF
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this ay of 20�by this l(;_day of 201,5_by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- tate of Florida ) (Signature of Notary Public-S e of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of in L S-L4
Produced Produc .'I! ' ikle
U
�. A CRESPO =•c �*e MY COMMISSION O
MY COMMI #EE171214 ON#EE1T
Commission No. ) Commi sP, ( �
IRE3 ebruary20.2016 40 ' �� fUary 20,2016
••,960153 Rom .me �Ortdallo .00m
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014