HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO
MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date.. Permit Number: INO-
00W
rte ' RECEIVED SEP 15 1015
Alin._ . . �� �,�A .- _ � 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 LOCATIaN
Address: a�3 ���"a,r� ��-�•
Legal Description:
Property Tax ID#: i`'• - 1 I ( " bio? Obd- Lot No.
Site Plan Nam CD,zts -�ak-c' + �- Block No.
Project Name: � ��- c� -r- 140""
Setbacks Front Back: Right Side: Left Side:
} < ''''
DETAILED DESCRIPTION OF WORK °��
...
�1
CClNSTRUCTIONf INFORMATION ,
µ. .
.. F
Additionalwork to be pertorm,ed under this permit-c ec a tat appy: 5-00
_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:$ �� Utilities: Sewer _Septic Building Height:
OW,NERjLES5�EFE #fiCONTRACTOR P
Name cv'}+{� 'r'r• �.���ti� iNti_=-;v � .Name: iLr13 1�m .., %x ,K s'.—,
Address: 'PT Zig 7 y�.e d Company: ,o��� gc7lesri3
City: State: Address: Z 4),
Zip Code: 3-3'-1 1 Fax: City: 61-6 Stater
Phone No. 5 6 1 '-?1� " !9 Zip Code:3.ir5Z 3 Fax: 3 S-5F3f?-Z&I
E-Mail:�TAT lore S APhone No 95Z -5 e- e&ll
Fill in fee simple Title Holder on next page (if different E-Mail, 6 (c,h ir DPS-
from the Owner listed above) State or County License C G C X41�0 3
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL qQN I UCTIONIIENIAWIWORM,ATION
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 f r
im rovements to your property. A Notice of Commencement must be recorded and posted on the jo ite
bef a the first inspection. If you intend to obtain financing, consult with lender or an attorney befor
comq)qencing work or recording our Notice of ,ommencement.
Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF '5k- Lyc VQ, COUNTY OF S� -L4c.'yR
The forgoing instru ent was acknowledged before me The for oing instrument was acknowledged before me
this 15 day of �t± ___1 20 15 by this day of 20�5 by
Dy,no,\� � 011k+1.'\s . born0,\k � 0\ CkAP\
(Name of person acknowledging) (Name of person acknowledging)
D `
(Signature of Notary P lic-State of Florida) (Signature of Notar ublic-State of Florida)
Personally Known OR Produced Identificat• Personally Known OR Producei �
Type of Identification ��Ns ctda Type of Identification n"r'v` oEP grate o��t 2p16
Produced L l.— FNNPGt to otFtO 2p16 Produced �- n�ntaty pobEXp��es�eC a�g1
�E gra c,6 P,n„ua c , som #EE a5 ssn•
Commission No. E1r<5 NotalU l)x0e#EEoacyPsSQ' ommissionNo.t� `� _MJsomj) Sc ��iconalNotacyF
:PQM.;, so \Ss�o° i\p°atN >J F off: g0nded tau��
=.��.
REVIEWS FRON o
.`,gpNC SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNT ' KEVIEW -`REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014