HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 1I IaI�5 Permit Number:
„ - t
RECEIVED NOV 18 2015
Building Permit Application
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:
Pj,@A'@SD
OE" lNRR4UEMiEN1' LOCAT)ON:
Address:1 l oo `J CSC eG✓1 3— 3kJ ✓N �x in q0(
Legal Description:
Property Tax ID#: y5da - 503-- Oa-)'.)S - Gad-� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DE�SCR�IPTIONfiF ' ®R
M&Af pXZ5 t c�.t%�(er ��e/ a.�J ��r�S r I iyc,.A./ 30 5a/ C.leclyfc- (,,-Ak-y,-
Additional work to be pertormed under this permit-check all that appy:
_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: $ :72gq. W Utilities: —Sewer _Septic Building Height:
OUI/�N
r CONTRCTOR _ .
Name o' tt e Name: J Wws E-fo(laba&n►-
Address:!qm 56Geclo UN� Company:gee 9(dW V4(vA(aY�6
City: �ei'&) b6h State Address: q9 aAJ J:� f
zip Code:_?jyg57 Fax: City: e SL State:
Phone No. �7o?_�a9- /S�Ff Zip Code:349 53 Fax:.-?7)-$19--?11'7
E-Mail: Phone No '-1Za-�7q-7d7?
Fill in fee simple Title Holder on next page (if different E-Mail Ree� J�Jc�►ti�h� 6D cA '+ . r'«fi
from the Owner listed above) State or County License CSC 11f 2:?925
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLE, E � L CONSTRUCTI��N LI: N LAW 1 4F0'RMAT 0.
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 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.
Signatu a of Owner/Lessee/Agent Signature -"'Contrafctor/License Holder
STATE F FLORI STATE OF FLORIDA Lam;
COUNTY OF COUNTY OF
The forgoing instrurr�a as acknowledge before me The for oing instr me t was acknowledge before me
this R day of N 8 20 by this �� day of d 20� by
e 5 \A CN
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Pu lic-State of Florida)
Personally Known OR Produced Identific ti6ri�� Personally Known OR Pro Pg 05tio
Type of Identification Type of Identification DEAN _State°��c0 p�6
Produced �- �- NNP�'t�ae°tFt0t20�6 Produced arypublic ,tes
Jr
21
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85 -�g.
c- �' \espe a6g�6�Scn�:}
Commission NO.` EE PUe .� No�atySl�� � EE Neta�� � Commission No.
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REVIEWS FRO T%.;;; ,;;ib� N SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUN R VIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014