HomeMy WebLinkAboutBuilding Permit Application Nov 0415 02:12p p.4
ALL APPLICABLE INF'Oj MUST BE COMPLETED FOR APPLI TION TO BE ACCEPTED
Date:_ Permit Number: /c��! I' ® 0:90
Building Permit Application RECENVED
Planning and Development Services �oI — 4 2015
Building and Code Regulation Division NOV
L E
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
'� ;M.Ef\fT LOCATf/0 1r:
PROPOSED.I-M:PRO
Address: t�Q 00 �-i�'f`f_( ncLr-&ert R-[kms.au
Legal Description: L..Akf_ WaOcl 13Ik_ 14 /7
PropertyTaxlD#: /301- (13-- 612q^ 1!wo - `) Lot No. 16
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D;ETAi1ED..DESCR.CPION'aF.1ItlO.fK :.`...,:
7'c/,6 ba-
CONSTRUCT.f,ON II ` QR,NITaO :::;:...,
Additional work to (ee e orme under t is permit—check a app y:
HVAC IJ G Tank ❑Gas Piping _Shutters a Windows/Doors
aElectric _Plumbing Sprinklers D Generator Roof
Total Sq. Ft of Construction: Scl.Ft.of First Floor:
Cost of Construction:$ 06S_0 9`0 utilities:0 Sewer E]Septic Building Height:
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ONER •LE SEE. ;
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Name %+-o n Name: -_Tn-,g9h r TrU(LU
Address: e� /� Company: C e;,,CLiS ��1tr4b;pc, sQ,(UIC.�.S
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e- State: L Address: (ala? S� A-v�
Bo 171an C..
City:��`'!"`I�/rG-C
Zip code: Fax: city: State: l�C.
Phone No. Zi p Code: 3K 152 Fax:-712 3.3,5r- 7,6 r'a
E-Mail: Phone No. 7 7 2 -33-7-34_5 2-
Fill in fee simple Title Holder on next page(if different E-Mail: is (04 rViOqrnaticom
from the Owner listed above) State or County License: 1 qZ9 1
33
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Nov 041502:13p p,5
SUPPLEENTL C. S7RUCTJt3 ,hLEI :.LRU1l1N�OR1/t�►TLON::: °. '- . ':
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _NotApplicable
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:
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.
5
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Sigrrarure of Owner/Lessee Agent ure of Contractor/License Holder
SPATE OF FLORIDA STATE OF FLORIDA
COUNTY OF SrV, Lo cte COUNTY OF i5t, Lt►G01
The fo oing instru ent was acknowledged before me The fo/r�oing instrument was acknowledged before me
this day of dEyrZi6L� 20 L by this=f day of A�OV'f M k 20 C by
1::�--ry ! 6
(Name of person acknowledging) (Name of pe son acknowledging)
{Sign re of Notary Public-State of Florida) (Sii7ture of Notary Public-State of Florida}
Personally Know ersonally Known Produti✓AF
ype o entica i ced KAYLA ALLEN o #�o c MY CQtAAINSSIQII fF9148fi6
f• 7w MY C¢INMMION#FF914d66 p(PIRES Sfplember 01.2059
Commission No. EXEIRES Se r01 2059 Commission No. s+o>?�so�ss Flat (ip Maeam
M1
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE )MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS !