HomeMy WebLinkAboutBuilding Permit Application 11/02/2015 10:06 FAX 10001/005
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:.. l0 13 15 Permit Number:_ IS��!771
Building Permit.App]kation
Planning and DevelopmentServices
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone.(772)4624553 Fax: (772)462-1578 Commercial Residential)_
PERMIT APPLICATION FOR:
To Select from dro•p
box, click arrow at the end of line
Address: .s857o Svnlo cru CirC�tr Ford Qi Flr S4 I
Legal Description: C 91S 41-0 U4 4bg ( O f 32037,,=_)
Property Tax ID#: _ 1312- S75 I - a I Zg- a,c,o -2_ Lot No.416!i
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: , Left Side:
��•C,c4y c�.h -Q),cis�icy k4\�e.� W�crr �c.�'eit_. W��-k. 4, iS-U
Additional work to be oerrormed under this permit-check all that appy:
HVAC —Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
nElectric 0 Plumbing Sprinklers Il Generator F]Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ G'7 5 0o Utilities Sewer Septic Building Height:
10,3111111 111 1:112151 0101 1111
Name AVeA tilu"-,s Name: o
Address: 573-G Sy R-64--r ('r :Company: t + �f1n �►n . wn
City: 5t-tic- l F'r�-Q erre State:_T-� Address: vS.W vA'r. V
Zip Code: 34t S-) Fax: City: Vo r�_ S�_. 1._vl�-,c State: 1.
Phone No. 7-77- 'Zip Code: Fax:
E-Mail: :Phone No. t� 7.�
01't C4 q
Fill in fee simple Title Bolder on next page (if different E-Mail'�'orxnn►n �trs�o+n���r,.b�vu•+ r.C:ytr�
from the Owner listed above) State or County License: C_ C_1`i to%Q
if value of construction is$2500 or more,a RECORDED Notice of commencement is required.
11/02/2015 10:06 FAX 1002/005
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DESIGNER/ENGINEER: Not Applicable !MORTGAGE COMPANY: Not Applicable
:Name:
Address: rAddress:
City: State: !City: State:.
Zip: Phone: Zip:. Phone:
FEE SIMPLE TITLE HOLDER: —Not Applicable !BONDING COMPANY: Not Applicable
Name: jNdme:
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 permitwill authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Assocretioh mils;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 heregy 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,wails,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 Commence0ont must be recorded and: osted on the jobsite
before the first inspection. f u 'ntend to obtain financing,consult with lender o attorney before
Comm. cin work or re r s our Notice of Commenceme
ignature of er/A Lessee ignature of Contractor 'cense Holder
STATE OF
COUNTY OF FLORIDA �7` ,�c COUNTY OF FLORID S, "5;.
The forgoing instrument was acknowleds—I hefore me The forgoing instrument was acknowledeed before me
this day of a0J„S-by this day of
112e Z,
(Name of person acknowledging) ((Name of person acknowledging)
�f
(Sign of Notary Pu ' - tate lorida) (Sign atu NotaryPublic-S e Flo a)
Personally Known Personally Known�_OR-,Pr ggei�tpfgg(gp
Type of Identificatio i Pa{3duT t Type of Identification Producw
LESL:r n
Commission No. �) MY COM ON#FF165172 '•' EXPIRES0ct ber 1,2018
j Commission No. c
?or n"'� XPIRE October 1.2018 vd1153 Florida otary ervlce.com
4( 3980153 Floridallota Servlce.com
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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DATE
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INITIALS