HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: t 'S Permit Number:
RECEIVED DEC 0 8 lob
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: 1:0%.. `A c;C
PROPOSED INPROVEMENT LOCATION:
Address: '� I.�N� yr �T f 1 n FL-, 4
Legal Description:
Property Tax ID#: ®^� tco i Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETA LED@S �IPS* ON +DF WORK:
L HAWN& OUT E�F-e-7iz14AL AME1, F69 MbRC-- GI INUIT- 5P/04E, (-OJV •I 16 FMM
0V1%ZH5A-V TD W JDE7�0z'OUND 3�l if
CONSTRUCTIO
lilt
Additional
rtiona wor to be pertormed under this permit-checK all that appy:
Mechanical _Gas Tank _Gas Piping —Shutters _Windows/Doors
Electric Plumbing Sprinklers Generator Roof
— — g — p — —
Total Sq. Ft of Construction: Sq. Ft. of First Floor: .
Cost of Construction:$ d Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRA
Name L~-r LN'PA9P Name: T �
Address: OLF-4NDOI�' , VF, Company: 6M eazeMic= ILC
City: Pte€ Stater Address: -7t
Zip Code: 349& Fax: City: FT,r1l;Ra'- State:FL
Phone No. n .5`13-'851C1
1 Zip Code: 3;"51 Fax:
E-Mail: Phone No (717z) 5--m-,?W
Fill in fee simple Title Holder on next page (if different E-Mail S505DAAP M15 0-YAWD.---Or
�i
from the Owner listed above) State or County License EL 13DO cI
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
" �i"y� �s'*rY j €.cwt:: `�: ���,: �a��;����. ;' > ,y ,�-,+•��s��f�w, ���® �a'�' +�"� � •
SU EM,ENr L CaN�T, UCT101U I:lE'N i.AW I F'U RMATkU, `
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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:
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
commencin work or recording our Notice of Commencement.
A
Sign atur wn r/Lessee/Agent Signature of Ctw
ct /License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me. The fgoing instr ent was acknowledged before me
this T day of �R.C. ,20�by this _ day of $d LC- 20 SS by
(Name of person ack owledging) (Name of person a knowledging)
(Signature of Notary Pub' -State of Florida) (Signature of Notary Pub• -State of Florida)
Personally Known OR Produced r `tONP Personally Known OR Prod t�d4 d �lotlda
Type of Identification �EPNNP S�a�e°c,6 2� Type of Identification Dp� "S�sDe0�6'6�
Producedfl �b\�o SOe g-10 � Produced 'VC-- 1.4Q •.,,, ��acy ice e�
,., .\�e g5 ss0. ,�,�r-rs;s ti—rcr.Exp EE 8`' psse•
N a�m �'p # � °�a y A P c•' tom 100� °�aty
�0�0 �•�0 o a1N � � My �°mcn�ss ��o0a1� <�•`�
Commission No. 1"r �Ay 0mt6aNa<� Commission No. �.
REVIEWS FRO ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014