HomeMy WebLinkAboutBuilding Permit Application 11/02/2015 10:07 FAX i7j003/005
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J
Bate:^ i 11.Z lam_____ Permit Number:
Building Permit Application
Planning and DevelopmentServices
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential �0
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[PE�MITAPPLICATION FOR: To Select from dropbax, click arrow at the end of line
Address: j
Legal Description: Mtk 5+i!_ ::L I,— -reSevvi /64 ;5tg o( 2$(q - 6r3/77
Property Tax ID#: 3?,ZZ_ 16 20 06.3 Lot No. 13-Q_
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:' Right Side: Left Side:
to c a vy� aK e.ICi yr�,V-3 �4zcL L(j 4e ' LJvz_ sv ice+
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Additional work to be�je Orme un er t is permit-c ec a app y:
HVAC L�1 Gas Tank ❑Gas Piping _Shutters a Windows/Doors
Electric ®Plumbing Sprinklers ElGenerator M Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
ElCost of Construction:$ 1141. DPS Utilities' Sewer Septic Building Height:
Name E. n Name: o
Address: -�301 rnHS+- tor's Cgmpany: Z r�r, 1�n
City: pert 61I Arte State: Address: W v V
Zip Code: Fax: City: QOA- S�-.L%NN4, . State:.
Phone No. -? ?2 - 4100- 5=1 Zip Code: 110\%4 Fax:-111,-31 50601
E-Mail: Phone No. ,—
Fill in fee simple Title Holder on next page{if different E-Mail. an tin �vu•, r,Cvb+r�
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
2004/005
11/02/2015 10:07 FAX
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DESIGN ER/ENGIN ESR: Not Applicable IMORTGAGE COMPANY: Not Applicable
Name: .Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: ^Not Applicable Ib6NDING COMPANY: ,Not Applicable
Name: Name:
Address: iddress:
City: ,City:
Zip: Phone: 'Zip: Phone:
I certify that no work or installation has commenced prior to the issluance 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 resul "n your paying twice for
improvements toZSZ*c1ording
operty.A Notice of ComnnenceinOnt must be record posted on the jobsiite
before the first in . If you intend to obtain financing,co, It with le an attorney before
corn ncin worour Notice ofCommOncem .o .
Sign ur w r t/Lessee Signature of Con ract License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF� '�',,(� COUNTY OF
The forgoing instrument was acknowleriapri before me The forgoing instrument was acknowledeed before me
this day of d OJS"by this day of ao 1J.6y
111Ci(U VA.
{Name of person acknowledging} {Name of person acknowledging)
{Sign of Notary Pu ' - tate loi Ida} {Signatu XNota_ry2rP_u4tlic-S e Flo; a}
Personally Known rodirred td ntifi a ion Personally Known _Og,,Pr¢ CEft 0fZM1AYA.
Type of identificatio P..r eiia d Type of Identification Produced= MI,65"
EXPIRES Ree ber 1,2018
tvtYCOMtjON#FF165172 Commission No. ea
Commission No. �% st63 Florlda otary ervice.com
XP3RE October 1,2018
(407139' 0153 FlorldaWta Service.com .
Revised 07/15/20114
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS