HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE 114FO MUST BE C5( NIPLETED FOR APPLICATION TO BE ACCEPTED
Date: ® Permit Number:� 0 \�C
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:
P OPpSED INPROUEMENI"LOCAT 111
Address:2B445 lAo4 s o(N kZat5 P eC CsL
Legal Description: S15Ln LA C-W- ¢., l'- aft_
Property Tax ID#: rag "�C7� � ��J��c - DOU'(O Lot No.
Site Plan Name: Block No. 59
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE Al'EED NE�SCRI'PTIO(U OF W®RK
CQNSTR�UCTION IN�FORa ,ATI'®N:
Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ -29Si-o c Utilities: —Sewer _Septic Building Height:
OWNR/LESSEE: C®NTR/ CT�R:
Name. �2� N pme: 15.A r
Address: C SS Company: r—& S le 1�
City: V�GI� State Address: Gant OkFQ n 't./ R!2 e-
Zip Code-' Fax: City: ✓ Pl -erg S,ltate:,C�
Phone No. �� Zip Code: ?✓l+q$ a- Fax:-172 4�o7-)3S`t
E-Mail: Phone No :7-12 4 �c2)^q(,o
Fill in fee simple Title Holder on next page (if different E-Mail �j 302 $$'Cs✓ 0.o GOM
from the Owner listed above) State or County License f�C pbO
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
AM
,..awn- _. iJ _ .:`;, ..z-s-'_4M';....3'. e'r..ti .' 3• rrot '.. � ,.a,.r........ _
DESIGNER/ENGINEER: N I Applicable MORTGAGE trOMPANYc _Not Applicable;
:Name: Name:
Address:: Address
City: State: City: State:
Zip . Phone. _ Zip: Phone:
FEESIMPLE TITLE":HOLDER: _,Not.Applicable BONDING COMPANY. _Not Applicable:
me Name:
Address: Address:.
City, City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTORAFFIDVITt Appl cation`s"hereby made.to-obtain a permit to-do the,wgrkand,iristallation.as,md catedi.
certify that no work or installabon.has commenced prior to.the issuance of a,permit:
klucie Count ,makes no:representation thatis�granting.a permit will authorize;the permit"h'Iderto:} uild the subject structure;
which Is in coni ict wrth.any applicable Home Owners.Association rules;bylaVds or.anc]covenants,that may restnct"or'prohIN such
structure:Please consult`with your Home.;Owners''Associa._ n an 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,"p.erform the work
in:accordance'with the'agprovedplans,the Florida Building Codes and St.:Lucie'County:Amendments:
The foltowing,.buildi'9 permit appl c. Ions`are exempt from undetgging a full'coneurrency review.room additlons;
accessory,structures,swimming pools,fences,walls;signs,.screenrooms and accessory uses:.to another.non=residential use
WARNLNG;TO QINNER:,YourUlure;to.Record a;Notice of Cpminencement may`result in your pay ng"tw ce for
Improvements to your property A>:IVotice-of Commencement must be recorded.and posted on the jobsite
before the first inspection" If you, ntend to obt6in, inancingp nsult:with_lender or.an attorney before
commencingwork or`:rec,6rdin our Notice of,Commencement.
%jn ture of Owner/"Lessio
gent Signature a Contractor/Lien Holder
STATE'.0F FLORIDA. STATE OF FLORIDA
COUNTY"OF Ct.d _ COUNTY OF C.
The fprg g instr eptwas a kno ledge before me The Pings ins en was"ack owledgedYbefore"me
this day of Y. 201 by thi day,of t(Y � , ,� 20�i "by
('Name"of--per"son:acknowle-dging) (Name of persgn acknowledging_).
(Signature of.Not„ Pu;lic State o,Flori a.'}; (Signature of,No" ry;Publ' =State:of Florida)
:Personally Known .. Perspn6lly Known
T STACEY GAFlG1A,_
Type'of"Identification '•` STAGEYGARCIA: ypeofldentification
SSION4FF0
Produced .�'. := `MYCOIyI(NI06 6
Fro'duced" _,; r IvltGeti'�l�tSStONi}FF006826`
�z PIRESi Ma "16,2017 May .
FRES i8,e0i7
ryPubkcUn�fe' , 't:SRP � eonBadTtUu(1ata7PuWcSlndenvatCrs.
Commission No. "F"' Commission No.
LA FrUDLRALO
REVIEWS FRONT °ZONING_ SUPERVISOR PLANS VEGETATION SEAT RTLE M. A.NGR,OV1
E
COUNTER REVIEW REVIEW REVIE-W REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED,
Rev. - MI