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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Qi_ Date: "C l 2� l Permit Number:'G 9 yCED OCT 0 71015 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: RT90 SE O INPRQI/EMENT L©CATIQN: Address: �� �U I�cr t-e•�(Y) C„r Legal Description: -T`8,Y 143 3-9, ^ 13() -0 O() �A Property Tax ID#: y33 �3 a - Oa0'�-GGd - Lot No. Site Plan Name: Block No. Project Name: ', t Setbacks Front Bac : Right Side: Left Side: DETAILED DD ESCRIPTION OF WORK: C©N�5TRLJCTlC7N INFCIRMATION: Additional work to be performed. un er this permit-check all that appy: _`Me Icfianical _Gas=.T..ank 't _Gas Piping —Shutters _Windows/Doors Electric _Plumbing _Sprinklers _Generator _Roof Total.Sq. Ft of Construction: Sq. Ft. of First Floor: -Cost of Construction:$ Z Q C Utilities: —Sewer Septic Building Height: O NER/LERSISEE: CONTR CTDR: Name K\ {`nn 10,% Name: Address a�4 �a��Q �d Comp ny /�" Chi-G G City: �t v\ ck^M Stater) Address: Zip Code:L"\400 Fax: City: State: C� Phone No. �Sa— ya�._� �� Zip Code: 6-CO-3 Fax: 7_120 E-Mail: Phone No Fill in fee simple Title Holder on next page(if different E-Mail from the Owner listed above) ' State or County LicenseA t (f,C�ow If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. Si1PPLEMENTAL CODS .R.UCTION LI �N LAW INFQRMATi3ON: 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 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 len r or an at rney before commencingwork or recordingour Notice of Commence !' Signature of Owner/Lessee/Agent Sig ature of o� r or/Li a Holder STATE OF FLORIDA �S ATE OFF " RIDA - COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of 20_ by this�day of dGT eQ—L 20_5Sby �✓lGG67 •w;�7 — - (Name of person acknowledging) (Name of person ackMmOnalkotarYAssn. ' ic-state of Florida xpires Jul 31.2018on # FF 146653.National,Ngta<y Assn. (Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida ) Personally Known OR Produced Identification Personally Known �OR Produced Identification Type of Identification Type of Identification Produced Produced Commission No. (Seal) Commission No. .(Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.7/2014 1010712015 13:13 Como oil&propane TA }772 257 0229 P.0021002 . .. "DESIGNERNGINEER: _Not Applicable MORTGAGE COMPANY; _Not Applicable Name: Name: Address: Address: City: Stake: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TiTLE HOLDER: _Not Applicable BONDING COMPANY: —Not Applicable Name: Name: Address: Address- City: • 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 Countyy makes no representation that is granting a hermit will authorize the permit holder to build the sub ect s ructure which 1s in conflict with any,tpplicable Home Owners Association rules,bylaws:or andcovenantsthat may restrict gr prohibit such structure.Please consult wit 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.approveq plans,,the Fiorloa 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 noxi-residential use WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in ydur 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 oh an attorney before commencing work or recording our Notice of Commencement: 7 signature of owner/Less /Agent 5lgnature of,Cont actorlL(censeN,gjder STATE OF COUNTYOFORtDAl�D1A-� f�i Jam — COUNTY OSTATE OF F., The forgoing Instrument was acknowledged before me The 7dayof.0M ing instrument was acknowledged before me this day of . 4�Q 5<e.. ,201 by this t-0-- ,201 by (Name of person acknowledging) (Name of person acknowledgin ) s=aA�+ t (SI ature of Notary yPublic-State of Florida) (SI nature of Notary Publl -State of Florida) Personally Known OR Produced Identification Personally Known OR Pro Type of Identification Type-of identification KEF11y HM.AGUM Produced KENNETH M.AOuoN Produced MY•CWM18alUH#M=7 NN Co 'bI IQN#FF020347 EX11111,1b11 AY P7,Y017 Commissigrt No. �Z�✓7 ( ES,MAY 21,8017 . Commission No, 4 �I +utat6taf+leeiaence Bonded uytl tat 5tata In+urenoa REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE ' COUNTER REVIEW ' REVIEW REVIEW REVIEW REVIEW 'REVIEW DATE RECEIVED DATE COMPLETED ev, �•Q� � rim. 10/7/2015 11:42:37 AM PST (GMT-8) FROM: 5614200804-TO: 17724621578 Page: 1 of 1 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 AFFI®VIT: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 Coun makes no representation that is granting a permit will authorize the.,perat 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 fallure 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 posto on the jobsite before the first inspection. If you intend to obtain financing,consult with len r or an a rney before commencing work or recording our Notice of Commence Signature of Owner/Lessee/Agent Sig ture of C( or/Li a Holder STATE OF FLORIDA _ S AT OF FLORIDA COUNTY OF UNTY OF Thefor oing instru s acknowledged before me The for oing instrument was acknowledged before me thisd .y of 206 by this day of CAGY ir�s. 20 1,57by 2 j( &J✓/C.G (NamePoerson acknowledging) (Name.of person ack .c MNotary Public-Slate o Y qorrµ�.Expires Ju�14166�3 "fes` ;•�'�� Commi,sion#FF (Signa ure of Notary Public-State of Florida .(Signature of Notary Public-State of Florida J l�ii�J���. / Personally Known V/ OR Produc Personally Knowny OR Produced Identification Type of Identification ¢ Type:of Identification Produced Produced �v,e► �7kc' Commission No. y .•(Se06Sf8y �_ Commission No. (Seal) STAT REVIEWS FRONT ZONING 9I� RVISOR PLANS" VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 1`'133