HomeMy WebLinkAboutBuilding Permit Application (2) ALL APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -- Permit Number: �C, 49• &V�
RECEIVED
Building Permit Application SEP 21 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: I$2 SE S,elVa 5+.(.Llet-2— 3'i�Ig3
Legal Description: R_iyrrP0.(ZL- U f1BI K L02 - sok (O
Property Tax ID#: 00D2 V' Lot No.
Site Plan Name: /� Block No.
1
Project Name: 192- 66 SELV4 Cr. 2F-A2ooc
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
u h I n q La Ve-Cor - ,r1r'1m6z e ry sy�.v�F e -zooFq Ivo0.0 .oery
-3/,6� .
CO'NSTRU'CTION INFORMATION:
Y
Additional work toe performed under this permit-c ec a appy:
❑HVAC 11 Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
❑Electric ❑ Plumbing []Sprinklers ❑Generator Roof
Total Sq. Ft of Construction: 9aOy S . Ft. of First Floor:
7, opo
Cost of Construction:$ � Utilities: _Sewer[]Septic Building Height: /0
OWNER%LESSEE a CONTRACTOR =
St .ft,.t. A tX3
Name Name: KLA? Poo6 nA L'Qlle.lo.
Address:'`t76 L Company:
City:ConmI (-(-C.n Stater Address:165ft ShGdowCree(-Vil I CI C.
Zip Code:-75 010 Fax: City: 1 Q}(0 W 0 it l State:. FL
Phone No. Zip Code: 2)5ALD3 Fax:nL0 I Q(QS5^]3Z
E-Mail: Phone No. (D (Z ICI
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: CCC 152?RcZ
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. �Cyy`
SUPPLEMENTAL CONSTRUCTION LIEN LAV1/:INFO.RMATION
Yt� �x
r _ . . .,,
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 n the jobsite
before the first inspection. If you intend to obtain financing, consult with lend e an at hey before
commencing work or recording our Notice of Commencement.
_Signature of Owner/Lessee/Agent Signatur f Con actor icense of
STATE OF-MMM-1 exlqS STATE OF FLOR Q_A p
COUNTY OF men-J-00 COUNTY OF 4XJ1Yl ��GVCLj'l
The fo oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of Se_-�4.5_fn 6,a 20 IS by this ILQ day of 20 ff-�L by
r%Yi rgip. i . t::17
(Name of person acknowledging) (Name of person acknowledging)
= 1 FY,e�p: SARA D.MARTINEZ
11,
MY COMMISSION EXPIRES
(Signature of Notary Pub 'off (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Produced 'T x— TJ Z— Type of Identification Produced
Commission No. (Seal) C (Seal)
NORMA M WILL1
ia'. 74f�
MYCOMMISSION 15:15115
Revised 07/15/2014 '��: „..'` EXPIRES January 06.2018
407 306-MW oem
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS