HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _ Permit Number:
' '' RECER' =D OCT 16 2015
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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 X
PERMIT APPLICATION FOR: Roof - �n
OPOSED IIVIPRQVEMENT LOCATIO
PRN
Address: -
Legal Description: - -
Property Tax ID#: 43n I - (ol s - n I a9 - nnd:3 Lot No. 16- 1F4
Site Plan Name: �i� �� Block No. [43>
Project Name: (5aL)N
Setbacks Front (:95J Back: 07 ,S Right Side: S^ Left Side: . 5
DETAIIED DES'CRIPzTION:OF
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CONSTRUCTIC3N INFORM�4T10N
Additional work to be nertormed under this permit-check all appy:
HVAC E]Gas
Tank ❑Gas Piping _Shutters a Windows/Doors
11 Electric 0 Plumbing ❑Sprinklers Generator Roof
Total Sq. Ft of Construction: 9 S . FtFt. of First Floor: /DO 8
Cost of Construction: $ � /9 UJ Utilities: I' 1Sewer 0Septic Building Height:
OWN ER/LESSEE: CQNTRACTQR
Name�� /�-�b 1� Name: ' L � �'1 a
Address:6900 (.,c)t a •fir Glard e-, fLJ U Company: A � C°
City: P=� _ 14At u State:W Address: 9) ,S_`AS ( ^�I��TI-319
Zip Code: �-9 5 Fax: City: , UC_0 State:(
Phone No. Zip Code: Fax -Q_-,3�78-7-1 j/
E-Mail: Phone No.
Fill in fee simple Title Holder on next page (if different E-Mail: -e
C46-
from the Owner listed above) State or County License: 3U10
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Sl3PF�LE MENTAL C 3NST UCTIt3N �1�F�ORMATIC}{� � 4
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.DESIGNER/ENGINEER: vNot Applicable MORTGAGE COMPANY: vNot Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: __VNot Applicable BONDING COMPANY: "ot 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 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
commencipg work or recording our Notice of Commencement.
/mss Js
_Signature of Owner see/Agent Sig ature of Contractor/ (cense Holder
STATE OF FLO D STATE OF FLO A)
COUNTY OF 11L CASL COUNTY OF , _ ! QJ_ CJ_,`
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisday of P1Ca 201_1'�_by this L�day of / t4 20 1 — Y,,..,,. ..,,
�s.......No
(Name of a edgin (Name of perso owledging) M K M
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gnature of Notary Public-Sta e o a i nat ota Pubr - tate of Florida E o ZZ
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Personally KnownyOR Produced Identification Personally Known �� OR Produced Ide 'fAatjp
Type of Identification Produced_ Type of Identification Produced i -n r
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RYAN LYNN IS PCaO��LLUPY 3 o N C
Commission No. = " MMISS(8WPFF17o227 Commission No. ( alb
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EXPIRES218 October 21, Q
(401)398.0153 Floridallotary ery ce.
Revised 07/1 14
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS