HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l b 3 2015 Permit Number:
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
PERMIT APPLICATION FOR:
„PROPOSED INPROVEMENT10CATION
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Address: 7 0 j O Ca-bcLY10. Lexyie
Legal Description: L—o-ke-,wO Ool 'Pay-k — 0 ry i+- t l — 13 LK 149 Lot
MA-P [3/L2N) �r-0 R-- 3 ( T-1--14-2) Q
Property Tax ID#: 1 301 —(P 13 —022 7 000 ^ 1 Lot No. C�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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CONSTRUCTION INFORMATION
Additional work to be performed under this permit—check a tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: 'I — 1 to CD Sq. Ft.of First Floor:
Cost of Construction: $ l D �O Utilities: —Sewer —Septic Building Height:
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OWNER/LESSEE %CONTRACTOR e "
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Name Keri Sa,U3 Name: 0 W.ne r
-Eo : ,,i n.s tcL l l
Address: 701.0 CzL_b rio_ Lin • Company:
City: 'Fov'+ P1r- rCe- State:- Address:
Zip Code: 31-C1 51 Fax: City: State:
Phone No. -7 7A — 'I a-"— g 0 Zip Code: Fax:
E-Mail: (/el l a 5a Ict5 Va Phone No
Fill in fee simple Title Holder on ext page(if different E-Mail3��`
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: _ t Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: X'Vot Applicable BONDING COMPANY: 'XQt 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 recording our Notice of Commencement.
Signature of Owner/Lessee/Agent _�+°` `� Rotary AAIB FF actor/License Holder
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STATE OF FLORIDA 3F C0mml si ,p �1. IDA
COUNTY OF S�'• LIA G 1 ;,;;, MY comm: xQ F
h National Not 1
Ny A
The forgoing instrument was acknowledged before me rument was acknowledged before me
this `7 day of (]CTbZE2 20_L<by this day of 20_ by
(Na of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida )
Personally Know Personally Known OR Produced Identification
Type of Identific 'on•�a�P Type of Identification
a� v , CATHIE LEE STULL yP
Produced «�= -State of Florida Produced
My Comm.Expires Jan 27,2018
Commission No. 'N;", oP F R C CommissOel 086842 Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW -REVIEW
DATE
RECEIVED
DATE-
COMPLETED.
ev. 7/203.4