HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED U
Date: Permit Number:
26-
, � r=: RECEIVCD SE�P .29'2015�13
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:
PROPOSED INPROVEMENT LOCATION'.
Address: 3401 -�L v cjwS � c4
Legal Description:
Property Tax ID#: 6 0 / 19 0 0 0 Lot No..
Site Plan Name: 1 JTC & TV Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION, F`WORK:
Cp ,JnJe� Dp C NLi ��sca.clye �
CONSTRUCTION.INFORMATION
Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ /SOtl' Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR
Name Jcre.lk\Se.-)ui Ye 8J 1%roa d,,4s ,� g 2,uC- Name:
Address: .3601" O':Lyde dn,a / 3 69u-e Company:
City: El Pr1,P rcc.4. State: Address: / A/Wi, ted,✓ e
Zip Code: y 4 Y 6 Fax: City: ET tp-tf v cJ- Stater
Phone No. --.>-7i-- Y4- 6R9/ Zip Code: Fax:
E-Mail: Phone No 7? Z - !Z �-6- 6 9 " I
Fill in fee simple Title Holder on next page(if different E-Mail k Ici LQS112Q9 4C Ir,L Q coo 1, caow
from the Owner listed above) State or County License EC (3 06 662 Z
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENONSTRUCTION'LIER 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:
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.
Signature o Ow er/L s e/Agent Signature o orlf rac"11cense Holder
STATE OF FLORIPA STATE OF FLORIDA
COUNTY OF �. �-yc t� COUNTY OF 5k,
The for oing instrument as acknowledged before me The foigoing instru, ent was acknowledge before me
thisa� day of S� , 20\5 by thisa day of '�p� ,20_ by
� o G �av d���nba
(Name of p rson acknowledgi ) (Name of p rson acknowledg g)
(Signature of Notary Public State of Florida ) (Signature of Not P lic-State of Florida)
f BENS �o - NP Not
Personally Known OR Produced,;.lde� t is jtmb`4� 0�6 Personally Known OR Proceed deny 0ic ►aye 2�1
Type of Identification p�Pb�o Sespeo 586,s5� Type of Identification PµY�P�e-c, �o�aco�m EXp�c#EE a5
g76 as
Produced L QL ,yQ° ��e`` ��� o�a��P Produced Q ;z.`- J.. m�ss�oo a1N��a�Y
\Ss�o�a �N , •o �am 0\1
01
Commission No. P .1�My G �9�N Commission No. <5 � EOFf 6
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REVIEWS FRONA6.4r ONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW. REVIEW REVIEW
DATE
RECEIVED T_
DATE
COMPLETED
ev. 7/2014