HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a.3 Permit Number: �s C�
n *
RECEI'"7D NOV 231015
,. 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: GJ00&�E t) pCE-Aje67
PROPOSED 1NRROUEMENT LOCATION
Address: 00-4" .&4114 bR FT A/MM6- , )CL 3 qq,_ /
Legal Description: GAleE 0,01) BAR/C - 1))/7' - &K /// 1-1)7- /.0
(Aid /3 /OZ,! OR 37-7a - 690)
Property Tax ID#: /30I lO//0.2 </D 000 7 Lot No. /O
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:_X Right Side: Left Side:
DETAILED DESCRIPTION OF WORK '
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to Fool WiGH 5 �'&Ei woOD 6ti ,DiTiy%Cj�K ��We E 8X Q4 DF
CONSTRUCTION INFORMATION
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Additional work tobe pe� orme.T under this permit-check all at appy:
_Mechanical _Gas Tank . _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction:__ .rG Sq. Ft.of First Floor:
Cost of Construction: $ 7SQ.(1° Utilities: —Sewer —Septic Building Height:
:OWNER/LESS'E,E CONTRACTOR:
Name 77A907AQ4 I301,VeIZE Name: h"6- -&12/zb—VS–
Address: _670.S //lJGdA AR Company:
City:- /)T X/a46 State:f--I- Address:
Zip Code: 90951 Fax: City: State:
Phone No. ' 79 - Zip Code: Fax:
E-Mail: CCOG'Ql e 9 hfil t,. C449 Phone No __9 22 - 40S- 1112,5-
Fill
1/zSFill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW NFO MAT
ION
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-h'ereb' y made to obtaih'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. ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws.or ah9covenants that.may restrict.or prohibit such
structure. Please consult with your Home Owners Association and review your deed'for any restrictiohs'"Which may apply.
In consideration of the granting of this req\uested,permit"I:do hereby agree;that I W'ill;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
commenj4ng work or recording our Notice of Commencement.
4/m - 9,Z__.Z .!==
Signature of O er/ .ssee/Agent Signature of,Contractor/License,Nolder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5`'C . L \ '� COUNTY OF
Theoing instrumentwas acknowledged before me The forgoing instrument was acknowledged before me
this day of 06 20\5 by this day of 20_ by
_5I% 1*,0 �-h :4 ;� -e- 1n', Y\ Ckk
(Name of person ackn ledging) (Name of person acknowledging)
•
(Signature of Notary Pub State of Florida) r (Signature of Notary Public-State of Florida)
Personally Known OR ProduSedaden E,'Scatf���is 460 Personally Known OR Produced Identification
Type of Identification ctP�,C Skate°� ° Type of Identification
Produced �• ,;y'P�'�., ota�1 Pnb �pitas DeC.,g7E� produced
R�•.k EE 9-
`# _.�tnlola�yP-
Commission No. Seal).
Commission No.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE- ' MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014