HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0 �'6 Permit Number:
RECEIVED
Building Permit Application OCT 2 6 2015
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: I
-
f�C3�R � �t11R
Address: AQ -7 z&Lo✓ti S Lr-p_ 61-r4-
Legal Description:
Property Tax ID#: Cl 00-73 - O o 0 ' 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
�-';�.�: cl� "''�L ��&4��d'3��c`�. 'nw- �''� ,t��•3- `. �"-9 s 'd M'" .. � �- „ash`".. �- r^ + "�`�-www" `r a z
�f-�' �I�EQDESCRI;P �l� �O r�``Q�t' �� ` '�� :�� •;h �����- � �� -�,r � f
'10 4 w11d � � ti&
"k-S ' s
1v � Yu .. 1"p+x'.• 1_1
. � $,".
In
Additionalworto epe orme rider this permit-check " a 'W'n'.;a` �-r..+'�kKi� - }`-.:=. -,4:,:� :.t_ -a .: '-'. cr`=sr•`N
a 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 • DD Utilities: —Sewer —Septic Building Height:
„r_ -a'a $` :§�v e�, '-” --x"aa .,�.
3 �' --'.z'�--h, s & f r r e ,e-a s. e--:-�' M A,aW-
O _�(ER �E�SEt , 1R -n_
Name 1 _ �O,�S Name:=,l.r' C J04-�vN
Address: /0 7 .vancl.��-per �'i�. Company: C,1� L.Pr Joi "..Sv�
City:P. pm-c-C, State: Address:: 170 1 ' S.— 3`7 " Y 1
Zip Code: f-7
_\ Fax: City: • f.4-ez State:
Phone NoL77-!) LIZ- - 94,19 Zip Code: 3LLl-7 Fax:
E-Mail: Phone N� 70 1- 3 0�
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License 6
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
�f1 f�"x�,� £"` ` i'F���1��
SCFPAR'I,EMEiT1zCONSTRC}�T(_� LIN�LAWl�FORMT1t7lU
15SOO 'y,._..
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:
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 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
commencing-work or recordin r Notice of Commencement.
Signature of Owne ge Lessee/Contractor ignature of Contractor/Licens er
�.
STATE OF FLORID - = ``,pp'=� STATE OF FLORID — .....
1901��T.•` i
COUNTY OF COUNTY OF
mK
The forgoing inst ent,was acknowledged Jae ���c The forgoing instr ent as acknowledge bef 94�o
this day of 20 b �S m thisay of 20 ire
9..y< �cnro
P mom
v NTg2 a-c�' LC
ame of person acknowledging) (Name of person acknowledging) .
tDN N
ignature of N ry Public-State of FloridV) V (Signature of ary Public-State of Florida )
Personally Known --'� OR Produced Identification Personally Known /OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) "Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014