HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ) 11
Date: "� �� Permit Number: Q ��L
RECEIVED
Building Permit Application
Planning and Development Services NOY 5 2015`
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: Window/door 0
PR�PC►SED IM'PRQ1/EMENT LfQCATION r'� ;
Address: �a� �' die 12100 D
Legal Description: er?e/✓OOD ,. /J /1
(.vim` 3o v.,zV AC_ 6� 3-73
Property Tax ID#: f X 01- o 3 as - 000 - 0 Lot No. d
Site Plan Name: 8,4g (-- IJL 1y Block No.
Project Name: D e-MIc o Re-517 66—
Setbacks Front Back: Right Side: Left Side:
�DCTAILED D'ESCI�IPI'ION OF Wt?RK � � ;
/6 X-1
%At 04eT JeA-7jS;D -/Do 0 0--
CO S Rucl"ICIN INF, MATION� r
z :
Additional work toe e orme under this permit-check a appll 'r
\ OHVAC E]Gas Tank 0Gas Piping _Shutters W4/dews/D oo �
11 Electric 0 Plumbing Sprinklers ElGenerator R_Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ /'��� Utilities:Sewer Septic Building Height:
C*1fUNRjLESSE� . j t CONTRACTOR F
Name 17 =i2 /Dewjto Name: DZ�JN/S
Address:2U7 Sh ,f—uJOUQ Lr�/vL� Company: 4LLiC7p 17o0l�s Sa PL L(-(a--
City:
LQCity: �� /�_72G� State: Address: /S 1 S/IJ S C'T
Zip Coder 9Fr; - Fax: City: &4 PH"Jy State:
PhoneNo. d/ , !� �� �.�/ Zip Code: 536�d Fax:4?5zl
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:YJ/��1 (?a fV—dOO r5< Ly/Y'--
from the Owner listed above) State or County License: (a&' 033 1-3-7
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTIQN LIEN LAUV INFORMATION
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/ s r
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DESIGNER/ENGINEER: 4eNot Applicable MORTGAGE COMPANY: of Applicable
Name: Name: .
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: lot 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 Noticq of Commenceme .
_Signature of Owner/Lessee/Agent Signature of Contractor/Lic nse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF C iQrfZ�l COUNTY OF ArIzIrCA
The forgoing instrum nt was acknowledged before me The forgoing instrument was acknowledged before me
this'Z,2)day of %b C 20 L!� by this 16 day of Oc,�067_r 20 1 T by
1 lV lS u M eLG l DtWINIJ 0
(Name of per n acknowl ging) (Name of person ackno edging
—(-Si tures No r Public-Sta orida) (Si ature of otary r7P'bStat Florida)
ersonally Kno n OR Produced Identification ersonally own Vim. OR Produced Identification
Type of Identi cation Produced Type of Id tification Produced
•4P':Y.PYe:•i S NRY RAMIR¢ Commission No. .•�«R"°rev-; Sea ENRYRAMIR¢
Commission No ==4 IV,I�C 1v�141SSI0NBFF102359 =+: �} +, MYCCMMISSICN+FF102369
EXPIRES:March 16,2018 �,• ;a EXPIRES:March
� •r,,,, eo nru otary public Underwriters
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS