HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1a\\� \5 Permit Number:
RECEIVED DEC 161015
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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: To Select from dropbox, click arrow at the end of line
PROPOSED'IMPROVEMENT L'OCATI'ON:.. .
Address: --mbpTnr'; (dZ2CCc
Legal Description: I-AKE !aaeT <SIBI S- SLAT L'O. OY)E 101 5-3 09 3'I 2a- I �S(,
Property Tax ID#: �yc�G,— :d3-W69- Quo- a Lot No. �53
Site Plan Name: Block No.,00)f 0l
Project Name:
Setbacks Front Back: Right Side: Left Side:
.DETAILED DESCRIPTION`-OF WORK:
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LF. roo-F
CONSTRUCTION. IN FORMATION:
Additional work to be rtormed under this permit—c ec a app y:
HVAC Gas Tank FGas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator LEFRoof
Total Sq. Ft of Construction: � , l7� S . Ft. of First Floor:
Cost of Construction: $ ���5 Utilities:-Sewer Septic Building Height:
OWNfRAESSEE � CQNT.RACTOR:,
Name �SC�S�7i7 /}7�(./�&� Name: N- JAry t)
Address: Rags _5,'gnb pXnE ab1ZC ; Company: J RDTOAX -paWyll(, 0 g6rn6- 6M19PAY
City: QIY'F fl C-rCc State:_Z Address: /60/ 5£S• K)zCJ1 QCC9 6474CIC
Zip Code: 3WSo Fax: City:�alIT-51- 1_(-1CTE- State: FL
Phone No. LUQ— 9 a /- 3Zip Code: 3 V%Sa Fax: 955y
E-Mail: Phone No. '?-7?— `3 35- 9-S50
Fill in fee simple Title Holder on next page(if different E-Mail: 1, 1e/11JAY e 61pXDTA>Jg1 9QPF[*,%o eAM
from the Owner listed above) tate or Co my License: C CCD 3aS)3
If value of construction is$2500 or more,a RECORDED Notice of Commence ent is required.
M •
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
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 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
commenqLag work or recprding your Notice of Commencement—
s
_Signature of Owner/L ssee/A t Signature of Contra r/L' e e Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF .5 T LU CT COUNTYOF
The forgoing instrument wap acknowledged before me The forgoing instrument was acknowledged before me
this ay of 20)K—by this g,4hay of 2I t0_C /, &,f 20 L by
�i�'1rC�0 S• /�i'2� KJi2f� .�L�r19�
(Name of person acknowledging) (Name of person acknowledging)
(Signature f Notary Publi -State qFlorida) (Signature t
Notary Public State of orida)
Personally Know< AOR Produced Identification Personally Know o uced Identification
Type of Identification Produced Type of Identification Produced
Commission No. 6,Q:R7a?1y� ioS�d.4 P0, DENISE LE mission No.1.6'PIJW� 1
MY COMMISSION t#E 8rT814W °�A �6 DENISE LE
MA
* * EXPIRES:Marcie 2 ,2017 ,, MY COMMISSION q EE 742
BondedThnl m�qT : 17
Revised 07/15/2014 FOF F 6"'' Bonded Thru Budget Notary ices
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS