HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BC ACCEPTED
Date: Permit Number:
;�t��'-�,r•-.�rY';, RECEIVED OCT 02 2015
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)462-2578 Commercial _ Residential
PERMIT APPLICATION FOR: To Select from dropbox, lick arrow at the end f line -
•PR.
• ,. ::�_• � o �� a c cap, a
Address: 3`zSO S OCAv�3 �21VyN�r 2C� F15 ,1N _Ii
Legal Description: WP%UL G; JAAIL_OGii_r1 Ajr.�_lR `-Z�¢ \Wu 5 fy"u-Ag -
\
Property Tax ID#: O L7% GCap - 7 Lot No,
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
t,•{y¢�,/,y-tet J}�-t�(y� yKgq{ �,1:1. k�..y..y::.,'„_`r. ,.:k+k+'�'+' $:"Ky.
r na worKTODeoerrormea under i -check •" '
s permit a appy:
HVAC 13 Gas Tank []Gas Piping OGenerator
ShttiWindows/Doors
Electric El Plumbing Sprinklers Roof
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ �,COD •oo Utilities:[]Sewer LISeptic Building Height:
..... !.,..�......_.+. ..J.a.:.�a.T,..,1. . .:ly;$ .>-. a".. ,� 'i!.,r. _ o-•i'J'n,�.�>e:ar.�:: _
Name yy1.YAVL, Name-, AU_k uJl'f�1 +
C,(3vV Zdht..r,-7
Address: 1t4 LJ_1 company:p Y:—���'JLXzS laty� 0n.nI rioVJI i'l('3
City: fSAu A5 State: 7)X .Address: 1 1 �_A5r. SS :
Zip Code- -)5'LTt-1 Fax:_ _ City:_iLaLr,^�,.4 State: P.-
Phone No. C01- 223 - 4(003 zip Code: 3.30►:3 Pax:_)1G 49 YO
E-Mail: _ Phone No._�30S-
Fill in fee simple Title Holder on next page(if different E-Mail: ��� L ��� C,n�ec�re�_LOW)
from the Owner listed above) State or County License: CAC 1'W)-)$3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
biti:aepd eLSZ29b2ZZZ:01 :w0J.J 9Z:6Z tiiea-Lo--inf
�y^/p}y/ }j�.���){ /�•qj- ( .{(��., ` )i {h1Y[,{f., }t,,� •'f1;}•,f��".iR'W i i`•Y/T' j '•j••f-
i 1 3WR'Si /�{.��'}Y"�''({{ : .4•i M '.'tti+T '.'.�T.•• ate t..
•F �.. +tet ill: ';y.
DESIGNER/ENGINEER: `Not Applicable MORTGAGE COMPANY: Not Applicable
Dame: 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 on the jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing Wo recor
djag your Notice of Commencement. -,
s
_Signature of e5X ee/Agent SignaturtoWntra a License Molder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ro IJJrY1r oilol=— COUNTY OF i')A i Awl I
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
2—ID-
this �ti day of Q(—TU13i:d— 20(�by thisQ\ day of ()( , c' b1",. L ,20 X< by
o,;k• CION 2.c M-2. Ivyc.
{Name of person ac w ed ing) {Name of p S n a kn ledging)
(Signature of No ic-State of Florida) {Signature _ •blit-State of Florida)
Personally Known_OR Produced identification Personally Known OR Produced Identification k
Type of Identification Produced !�5�-'N -CCa ?�-3G 1 Type of Identification Produced S��
Commission No. Fr)SI S I t~IV>I•'. {S } �()} mission No. 1't't 1
04?tF,L 16)A,LVIS MARTI ,�yP 4rrb
' MY COMMISSION#FF1 1b18 A I�AL.VIS MARTIN
rF
'' ornf EXPIRES August 14,2018 ;; 8
Revised 07/15/2014 (401)396-0159 Ftondallosary8@me cam EXPIRES August 14,20
{407)985-o1S3 Ffor�dallotaryServ,Ce.com
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
t,,z:abed BILSti29t72LZZ:01 :wojj LZ:6T ziaa-4o--inr