HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �d 1� , Permit Number: ` 5 `4 6
RECEI'.'^D OCT6
1 1015
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 �C
PERMIT APPLICATION FOR: C..
K� 1111
PR4PDSE® IN'PRO�IEMENT L®CAl"I0' : 1
Address: 6 -�L �G`I'-/W h O zz_yl JD�-- �i� �T A
Legal Description:
Property Tax ID#: /-?OZ f —O! 0 Z Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
-------------
DETAhLED DESCRIPTION OF WORK:
CONSTR CT&NN IENF®RIUTA IO!N:
Additional work to be pertormed under this permit-check all 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: $ .� O O o o Utilities: —Sewer _Septic Building Height:
i
®1t1lNER/LESSEE:
T
/ C®NRACTR
Name oS e- L) Q ca '�N L Name:
Address: > .AVE' Company: k1w IING
City: f> State: Address:
Zip Code: Fax: City: �11�C State: �C
Phone No. Zip Code: Fax:
E-Mail: Phone No?"q 2-
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License_ , � �-
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
Sl1`PPLEMENTAI CONSTRUCTNN LifEN LAW IIN'FORf1/IATI®N:
10
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 COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit W 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 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 fora y 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.
Signature of Owner/Less e"e-NeVA Signature o Contrac L ense Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF 'S_ . Lyc COUNTY OF 'S Luc 'Z
The forgoing instrument was acknowledged before me The forgoing instrun a was acknowledged before me
this-\5 day of C]C"�' 20� by this \6 'day of U 20�S by
Socst- � ca �� .�� a 50 An d
(Name of p son acknowledging) (Nameiof p sonjackn wledging)
(Signature of Notary PubliV State of Florida) (Signature of Notary P c-State of Florida)
. . '�-
Personally Known OR Produced Identi ', Personally Known OR Produce
Type of Identification tVENs ,da Type of Identificati,- —' state of
L N�yP of F\oc YP „1,1111, public- 2016 .
Produced �L fl OP bGc,X15 Dec 18.666 Produced L av auaa,, yta�Y Expit#t)e 858761
Nolacy ExP`�' EE 8581
sill
i- - nal lwall AssQ ,
Commission No. � ' Co� l�o# tyllary P _., Commission No. Zht I
<•�_`ny �omm�o9hNai�n,�a.s�c
F
111111
REVIEWS FRO T -'ONING SUPERVISOR PLANS VEGETATI N SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Te-v—.712-03.4