HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �'
�'a �J-� Permit Number: �� � 1
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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:
PROPOSED (NPROVEMENT'LOCATION
Address: /S-7 "C (V+/&+A,y -4- /+Vt . pur
Legal Description: 12"V1- G C .
Property Tax ID#:_3yl 9'S�o ' Q��Y_ od° "� Lot No. I
Site Plan Name: Block No.J
Project Name: Are S'e.i,✓ee- :77r./ ,
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK77
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CQNSTRUCTION INFORMATION
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Additional wor to be performed under this permit-check all that appy:
_Mechanical _Cyas Tank —Gas Piping —Shutters _Windows/Doors
—Electric —Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
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Cost of Construction:$. A Utilities: Sewer Septic Building Height:
OMfR LESSEE CONTRACTOR _ a
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Name ,./� � fav Kr�e5 e Name �ul.� L- -
Add ress: X27. -n/6:;--/UA-2%4 1(I 4V ` Compan,y:/-cGvr7}c -ScP�IC Sew�cer� .�.,c
City: State: r'l Address: q/d'o
Zip Code: .3Y -5 Fax: City: State: F1
Phone No. 7172L— -7 71 - 3 3 Zip Code: 3 L/99 Fax:.-2 7a L/�Y-777P'
E-Mail: Phone No _'?7.'l- (/-4-- C. C///
Fill in fee simple Title Holder on next page(if different E-Mail Jvk.'J 6—Accu rA-fe. 1p. -//se v jk •ry--
from the Owner listed above) State or County License CSC /L�gss
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEIVIENTAL GONSTR'UCTION LIEN LAVA INFORMATION
:.
'DESIGN ER/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 thepermit 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.
Signature of Owner/Lessee/AgentSi ature of Contractor/License Holder
STATE OF FLORIDA TATE OF FLORID
COUNTY OF LuCt C—. COUNTY OF . t uc-t r
The forgoing instru� ment was acknowledged before me The forgoing instrument was acknowledged before me
this 2{F'}'day of i�lQV ec b-W'— ,2015 by this 23 day of by
"44L. I P.la Cvuks
(N a person ackno ledging) (Na o erson ac no ledging)
(Signat a of Not y Public-State f FI rids ) (Signat of No. ry Public-Stat f FI da)
Personally Known'I Personally Kno nIn
,(,A'—�tq4uce(AgiMbBiflcl$iWKS-YOUNG
Type of IdentificaiQrb— ° ANGELA E.BROOKS-YOUNG Type of Identificatio _'2e• �� Notary Public-State of Florida
Notary Public-State of Florida Produced ?'• +• My Comm.Expires Oct 12,2016
Produced �t—L.=. + .....—Expires Oct 12,2016 %9, a�; ommission#EE 210145
Bonded National Notary Assn.
missi n# E 210145 Commission No. ��
Commission No. rhrouahtd�f��llv::;arvAssn,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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