HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: dl k(bli 15, Permit Number: 15 00�cp3
RECEIVED OCT 16 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 V/
PERMIT APPLICATION FOR To Select from dropbox, click arrow at the end of line
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PROPQSE,D I(VIPRCiUEIV1,ET( T LQCATIQ4
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Address: I roe Llo K0DJ
Legal Description: - hG I - z) 3(o I 'EC) AC O 3''7Zxj - Z�Z )
Property Tax ID#: J�JZI - SDI - go (�- C7C)� -1 Lot No. 3
Site Plan Name: ' A Block No.
Project Name: n(e,
Setbacks Front Back: Right Side: Left Side:
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4Additional work to be nertormed under this permit-check
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HVAC Gas Tank [JGas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof b '�
Total Sq. Ft of Construction: 7000 Sq. Ft. of First Floor:
Cost of Construction: $ _�)? Iy�C) . Utilities: Sewer OSeptic Building Height:
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Name 0I V E Sl VQtn I PHIQ,, Name: n
Address:® " [A)DO Company:C.
Cit !per n- 1 ' ,
Y �� o G �l�l�i(.f'� State: Address: S S - Nl e me C r
Zip Code: .3VAP _ Fax: City: r_q
by� - U StatL.
Phone No. X72— u Q 1211 Zip Code: Fax:-m-335—
E-Mail:. Phone No.7)2-S3 S ,C�SS-0
Fill in fee simple Title Holder on next page ( if different E-Mail:
from the Owner listed above) State or County License: C 4C n 32513
If val6e.of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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 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
comm work or recArding your Notice of Commenceme
s
_Signature of Owner/Lesse Agent Signature of Contractor/Li se Holder
STATE OF FLSTATE OF FL
COUNTY OF ORIDA S,f • L�, . COUNTY OF ORIDA
The forgoing instrument was acknowledged before me The forgoing instrument s acknowledged before me
this Zi day of U�. . 20/s by this z- day of 0�F 20/J— by
ak(k A S' Hasty (I P-A0 S • f{ 0CAN
(Name of person acknowledging) (Name of person acknowledging)
l �M.e.cC. �• \�OP/JyK,f/�. �J MAACL-
(Signature of Notary Public-State of Florida) (Signature of Notary�Pubbl`ic-State of Florida)
Personally Known OR Produced Identification Personally Known Y OR Produced Identification
Type of Identification Produced Type of Identification Produced
pRY pUg�� B IT Pv p„
Commission No. ."'•. o Commission No. o"'.....ae� BRUC SSNER
* MY CONfM► ION II FF 211275 .
EXPIRES:April 3.2019 .� * MY COMMISSION�FF 211275
EXPIRES:Atiril 3,2019
''y)f0cFiL0 on a Bonded ThruBugelNotary Seryim
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS