HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a G 15 Permit Number: 5 fid- da5�
RECEIVIED OCT 16 2015
1-7241E 611- 71-
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 )-e'
PERMIT APPLICATION FOR:
PROPOSED IiNPROX/EMENT LOCATION: Mill
so
Address:?S0 16,gy n/A✓I
Legal Description: IAlc 4)00c/ Ag,-1 uHJ lof .23(Mge 6.3 1,"IA ) 0✓ 9y,.-)-,-2/q
Property Tax ID#: � 0/--0/,r/- 0 o O -,� Lot No.
Site Plan Name: JAY'dme, Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DET (tED DE�SCR�I'PTION O:F V1f0R�K:
=60NMEM10 nINFOR+l1/IATI....
Additional work to be pertormed under this permit-c ec a11 that appy:
_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: $ 6,73-7 � Utilities: Sewer Septic Building Height:
OWaNE'R/LESSEE F'.CONTRA �®R
Name aJ c?r d"'nC. 1 Name:
Address: 7,50 f cryJ z ,;n Company: eDc.J�ti l c� z)A / �o u
City: zz ez1/Cz State: Fl Address:
Zip Code:34/9.5/ Fax: City: f 4&e,fe-c State: Fl
Phone No. 7 o?D R Zip Code: y 9�l�' Fax: 772-yell- 4 Ps,3
E-Mail: Z—/A Phone No. 771 - 41oll,27l/61,
Fill in fee simple Title Holder on next page (if different E-Mail: Tn/Yi� �S ki,L/,f Q `/,4100
from the Owner listed above) State or County License: S.-CL // SSD
0-I
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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��SUPPL�Nl�E_NTAL C®NS�TUtCTIhN�F;ORI1/.fAT'P®�I
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COM ANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: P one:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPA Y: 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 the permi t holder to build the subject structure
which is in conflict with any applicablp Home Owners Association rules,bylaws or and cove ants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for an 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 Am ndments.
The following building permit applications are exempt from undergoing a full concurrencyreview:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory use 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 your.Notice of Commencement.
r
Si nature of Owner/AgenIfLessee Signature of Contractor/ icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The fo going instrume t was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20�5 by this\G day ofb c-M 20X_'�_ by
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(Name of person acknowledging) (Name of person ackno ledging)
(Signature of Notary Pu ic-State of Florida ) (Signature of Notary lic-State of Florida)
S i�da
Personally Known OR Prodi� �\02��6 Personally Known OR Produced I ice$ \oc`aa
Type of Identification Produced Type of Identification Produced- PNN \a\C -\6.
�� Nota�o m.E�oo#�o\N`\ara a §5,44" r es E�6��aryPss°
Commission No. ' + A. *�,,My� a�)�Na��O Commission No. , ll ,
09 �" '�''. y cNs Na\�o
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REVIEWS FRON ""a.r;-BONING SUPERVISOR PLANS VEGETAT \ ;^ yT RTLE MANGROVE
COUNTER'S REVIEW. REVIEW REVIEW REVIE REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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