HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: k 1 < <5 Permit Number:
RECEW-7D OCT 011015
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 -a!L
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line VJ c2� _e r
PROPOSED IMPROVEMENT LOCATION
1 �� f
Address: ' ,5-q02, ry1,�,rf/c, 10/: /60.J' /`�/'G�G P � 3y°1452
Legal Description:—4 �'�n � rG�fa fes ` U,,,'�-OS-,t3L SS 40x2
emo p 3a11r AJ) 62^
Property Tax ID#: , 3J/C y- C 16hf,-- 6027-3 Lot No. 2
.Site Plan Name:_�{r�,-enc r Block No. JS
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED. DESCRIPTION OF WORK ,
,CONSTRUCTION INFORMATION
itional work to be nartormed under this permit-c ec aMapplY:
❑HVAC Gas Tank as PipingShutters E]Windows/Doors
Electric Plumbing Sprinklers E_Generator Roof
Total Sq. Ft of Construction: 6_ ) S . Ft.of First Floor: / Z IF$
Cost of Construction:$ 's-00100 Utilities:Sewer Septic Building Height:
OWNERKESSEE '.'CONTRACTOR:.
Name Z�Aa"e Ai Name:
Address: syOz /119yrI /e- .Di; Company: .�a�w P/v,.,,.-�,�L•� ¢ /j1Crtc�t
City: `o.-7t -- '-c a State:/L Address: /-/Kfg
Zip Code:31,;S i, Fax: City:_�Ur�` S.n'f ���•� State: Y�
Phone No. Zip Code: 3,/9S3 Fax:
E-Mail: Phone No. -772-
Fill in fee simple Title Holder on next page(if different E-Mail: Gds-y �oc �jc�.-�, Y�• Coy^-�
from the Owner listed above) State or County License: cs�4 tc� � 1 c G✓
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLE_ MENTAL CONSTRUCTION LIEN LAM! 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:
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.
0'J'. 'k � C, A,, S
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FL'Tr
STATE OF FLO A n
COUNTYOF COUNTY OF ����_� C,
The f ring instr me t was ack owledge fore me The fogging instr en ra acknowledge efore me
this day of 20)S-by this�day of 20 by
�)p\(�o pi-vr�rkr ��VV\ �RVA
(Nam rson acknow dgi (Name person ac no g ng)
SON
(Signature of Notary - at •p� �A '°�9 (Signature of Notary ate of Florida,>,>>p•,�pHNSO�y''r�r;;�r
Personally Known O OR God �e ldenti icatigr Personally Known OR Produced3�ePnt � d6
Type of Identification Produced= :� �'� :�= Type of Identification Produced - :
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Commission No�_EE_� rS � :•o `� Commission No. (j 4%al) .EEo 19�
' 9 S ii0l•.;Nn
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS