HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: d��l'��J��- J t�u15 Permit Number:
—Ze. T " T.11 - 11 RECEIVED
Building Permit Application N®V ® 3 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:
PRQ,P05ED I�NP,RO.UEM,ENT LQcCAT
Address: 33� 5� `� Di _ -t"2F-f-1 ?:24S2-'),
Legal Description:
Property Tax ID#..% IM0 00(01 000 - 5 Lot No.
Site Plan Name: Block No.
Project Name /��a 1 Aa7of- s
Setbacks Front Back: Right Side: Left Side:
DE AILED DESCRIPTIOAddN OF WORK:
CON5TRUCTION iNF®RIVIATI�N.:
itiona_wor to a pe orme un er t is permit-c ec a t at app,,y:,
_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: $ ( r' 110 °o Utilities: —Sewer _Septic Building Height:
OUV �SEE: CONTRACTOR:
Name Name: � L VJ
Address: Company:6 OoJ`l-�L - -wo-o\(S Agr,)TS
n
City: ��T \ 1!2 (LC2 State:_ Address: -7-2,q SvJ
Zip Code: Fax: - City: eco Q-7C Sro��c i�, State:Y-J ,
Phone No. -] 7� - (o '7�2 Zip Code: 2>4H 5?, 3 Fax:
E-Mail: Phone No 17a - 01+D
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License Ce-e, 1 33 O7 -7 (o
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL 0NSI"Rl1GTIC?-N Li�EN LAW IN"FORMAI"IQ
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_tbe 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 o Owner/Lessee/ ent Signa ure ofxCoertrraFG_
tmi/,License Holder
STATE OF FLORIDA STATE OF FLORIDA _ �.�"*•••,
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged b 00 The f rgoing instrument as acknowledged t9RY iiie
this day of 20�C o thisy day of rny 20,�
o•m< a x�a
a Xc�C T -ov c
2 39�m • z �y m
< {
"IN Wcn cn z cn m
(Name of person ac now edgin (Name of person acknowledging) Z3
aji'l dA 1A A �XNa_�2 1Jh Z&4_
( nature of Public-State of F rida ,:� (Si ature of Not Public-State of Florida
Personally Known OR Produced Identification Personallnown OR Produced Identification
Type of Idents is 'on Type of Iden fication
Produced �ef Produced v• �
Commission Nov (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW ' REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.