HomeMy WebLinkAboutBuilding Permit Application Oct 08 15 10: 470 The Rockies 5613332811 P. 1
ALL APPLICABLE INFO MU/ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: %C/ ' L Permit Number: 1 51(3 - I 1
R�CEI'. ._D OCT 0 7 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)462-1578 Commercial Residential `
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT// LOCATION:
Address- S .l ' r
r—
Legal Description: +/__V_ P�'
Property Tax ID#: " !r7 �' ��Z y D�C! �j Lot No. 114 �
Site Pian Name:���(_7L.A e A-(+-7— Block No. 2`7
Project Name: �V}; , n.r 1
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to []GasTank
orme un er t is permit-c ec a appy:
MVAC Gas Piping Shutters ❑,Windows/Doors
Electric 1:1 _Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 3�0 2 ? G c� Utilities Sewer OSeptic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name Name s
Address:t'(Rzl F Company: LL
City: !' ~ `j > ;^C State: Address: 0I 1 z"
Zip Code:•7 n� Fax: City: Stater
Phone No. Y S' ,5�/ Zip Code: -5 `'(7y Fax /�'j��" �7L/
E-Mail: Phone N �- '1
Fill in fee simple Title Holder on next page(if different E-Mail:
from the owner listed above) State or County License: - C' f�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Oct 08 15 10: 47p The Rockies 5613332811 p. 2
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER., ____.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 orand 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.
i
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_
Sigroture of Own r/Less / ent Sig ture of-Corkractor i se o er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 20AM 6F cc o COUNTY OF P60-1,7-1
The forgoing instru en was acknowledged before me The forgoing instrument was acknowledged before me
this `- day of tb C ' 20 15-by this 'r?-day of OCi he/-.20 ZJ by
Mt �e'c.( �, G� t�Ctif" 9C'�CcL
[(N7e of person acknowledging)
(Na erson acknowledging)
(Signature of NotaryPublic-State of Florida) . ature of Notary Public-State of Florida)
Personally Known OR Produced! entification ✓ Personally Known OR Produced Identift tion
Type of Identification Produced r--]-, 7 C.IC.- 61-- Type of Identification Produced
r�l1Y�GLGk
Commission No. �= 1 LJ I �1 q (Seal) Commission No.�� `l r �R C (SeM "w NT
AMsAiwt HA M.HANLE.
NOTARY PUBLIC
OF FLORIDA.
NOTARY PUBLIC
Revised 07/l.5/2 wrl
Conw#FF145t99.
STATE OF FLORIDA Expires 7i!27/2018
REVIEWS FRO I • &fQ�7/27 AERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS