HomeMy WebLinkAboutBuilding Permit Application 12/07/2015 15:59 FAX 2001/003
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /�
Date: 1 Permit Number: 1512: lJ 1 2,�
RECEIVED
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Building Permit Application DEC 0 7 2015
Planning and Development Services PERNilTTii`dC'
Building and Code Regulation Division St.Lucie county, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Property Tax ID#: -{fJ��l I 1_0 - 0002 - ��nl Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertorme un er t is permit-c ec a appy:
❑_HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
❑Electric ® Plumbing Sprinklers Generator F] Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 2037. �3'D Utilities:cn Sewer F]Septic Building Height:
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Name_ Pri sfigin k V S Name: v m-
Address:� -I Ate4san4y;� 'bf*• Company: f
City: �u�, vt ���'-� State: e - Address: _1611 S .�hu� WIAc'. -,A, R
Zip Code: <34c S� Fax: City:�h(� (.c�c�i Stater
Phone No. -27 Z 7,2-q- K--3,41 Zip Code: Z491W Fax: 77Z - Y7i' J061
E-Mail: Phone No. 77 2- c57
Fill in fee simple Title Holder on next page( if different E-Mail: 'lis'/,-6raI., Cori
from the Owner listed above) State or County License:
if value of construction is$2500 or more,a RECORDED Notice of commencement is required.
12/07/2015 15:59 FAX IM 002/003
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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:
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 you intend to obtain financing, consult with.lende "an attorney before
commencing-work or r In our Notice of Commence t. �-
,,,
✓Signature of Owner Lessee/Agent " ignature of Coontrat•or/Lice`n^s'e Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF EA t_s .- COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrumegt was acknowledged before me
this —7 day day of 3'_C°. 20 /! by this_�_day of j. .d 20 15 by
i
(Name of person acknowledging) (Name of person acknowledging)
(Signatur :of Notary Public-StaC of Florida) (Signature of N,•gtary Public-State of Florida)
Personally Known �✓' OR Produced Identification Personally Known OR Produced Identification
Type of Identificati q. e Type of Identification P
u ' LESrLI'D'1 ZELAYA
4►. ..••'ILY pU"....
';ta:.........°c�:• L LID LAY�1 •�� .e„.
Commission No. �i, "= MY CoMq&W#Ff 1t1�a1 9 Commission No. + �^) My CotulWON#FF165172
57
,a:.` EXPIRES October 1, 2010 �,�•• ' EXPIRES October 1,2018
(401)MIA-0 153 phrifinNfiffiWARVdin.--- Of F�•.
µ07j398.015 --clallotarySeIVIce
ary
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS