HomeMy WebLinkAboutBuilding Permit Application SEP/15/2015/TUE 08; 13 AM Affordable AC FAX No, 561-355-5071 P, 001
ALL APP ABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED .
Date: '�3 _ Permit Number.
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 APPLICA110N FOR: To Select from dmpbox, click arrow at the end of line
Address: hf'z Sf S''67LVR 67--
Legal
TLegal Description: 91-Ver PAYIA-•W i-r 7-S/k �2_ Lcrr1,�f,4PYy 2,g) (at, sx-p-i'gY
Property Tax ID#:_.7W9 -_510 -0002 WO - Lot No.
Site Plan Name: 1.02 .-6 Pceve, e_r Block No.
Project Name: l zF.Z S5 S61l✓Ai e-/.
Setbacks Front Back: RightSide: _ _ LeftSide:
741-0 �.S
9(�, 5,
d� a wor o e e orme un ert rsperm -c ec a appy:
LJHVAC �GasTank �GasPiping _Shutters Windows Dors
❑ ro
Electric ❑Plumbing ❑Sprinklers Generator Q Roof -
Total Sq.Ft of Construction: Ft-of First Floor:
Cost of Construction:$ , -. .2�1�;os Utilities. Sewer Septic Building Height:
ta:c
Name f opr e, LC&? hoyY. Cir rf Name:
Address; !Pyo Company:
city: i17�� _.. State: _6(" Address:^.9.3/4-1 t-PreSr
Zip Code: -7r&tel Fax:_ carr: �Ir,��jdn Stater
Phone No. q. Zip Code- // Fax: _y
E-Mail: Phone No. f'?-406C
Fill In fee simple Title Holder an next page(If different E-Mail: &teW lei br'AFAteelae. C01'7
from the owner listed above) State or County License_ e4G
If value of construction is$2500 or more,a RECORDED Notice of Commencement is requirad.
SEP/15/2015/TUE 08: 14 AM Affordable AC FAX No. 561-355-5071 P. 002
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address'
City: State: City: State:
Zip: Phone: Zip:__. Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: - City;
Zip: Phone: Zip:�. Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may,restrict or prohibit such
structure.Please consult w th your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perforin the work
in accordance with the approved pians,the Florida Building Codes and St.Lucie County Amendments_
The following building permit applications are exempt from undergoing a full concurrency review.room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection.Ifyou intend to obtain financing,consult with leAder or an attorney before
commencing won r recon our Notice of Commencement.
DENNIS KUZN
MYDENNI$ ZN(:TZ `" COMMI331pN 0 FSE84
Signature of Own ssee/Age ; k`�tP1Rt;8 N ct r/Uce t.20
t t. octan. 77,207
STATE OF FLORIg°"° TE� FLORID
COUNTY OF P4 (S",aw COU OF r„1 iI
The for Ding instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of Cn f. . 20 r.�by this L±t-day of S i��4 ,201_by
T6,eA 94-9o,p IWO
(Name of person acknowledging) (Name of person acknowledging)
(Signature of fttiry Public-State o on a) (Signature Public,S ri a)
Personally Known Z-�”OR Produced Identi cation Personally Known ----611 Produced Identification
Type of identification Produced 1.r le/ Z Type of Identification Produced
Commission No. AF-� - n ' ), (Sea!) Commission N��� �� (Seal)
Reprised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS