HomeMy WebLinkAboutBuilding Permit ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application �3' .0 2015
Planning and Development Services DEC
Building and Code Regulation Division PEIAMITTING
2300 Virginia Avenue,Fort Pierce FL 34982Lucie County,FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click here
PR`OROSED INOVEMENT bC RPN
Address: (0006 p00P%UN, pL. T:OeT PIE:0c , 3�19�Z
Legal Description: pAU1 E1e0V 5)ID Wi L_
Property Tax ID#: 3 410- 563-03-10- 000-(0 Lot No. 3z
Site Plan Name: 'I H C)nA5 nC"ON Lk4 Block No.
Project Name: 1' OnA-t) ric tj a wq
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WCORK ���
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P PIAUE 8 WIWOOUD5 w111-4 11'1Pda_• SIZA F00 5QE
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„C,ONSTRUCTiON INFORMATION w
Additional work to be e orme under this permit—check a appy:
HVAC 13 Gas Tank ❑Gas Piping _Shutters 19 Windows/Doors
❑Electric ❑ Plumbing U Sprinklers El Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ 13, 267 Utilities. Sewer ElSeptic Building Height:
OUVtVEl2/LESSEE
Y CONTRACTOR
t..:F... . _ .
Name T"(DriN5 MC w&" Name. FL07JOA, i1DC'lE I0PIZCJUE1'=I01T
Address: (0018 400"IIDIA PL- Compan WPPJi"JE T- 5t)ZNEIr-
City: Ff- PIGE-L0State: Address: 4010 5W-
Zip Code: 3gq$2 Fax: �? City: 44 C)W4 -OoC>D State: fu
Phone No. Zip Code: 3331.2 . Fax:
E-Mail: Phone No. 9154• ZaZM U 15
Fill in fee simple Title Holder on next page(if different E-Mail: pe-vM%15 e -010 PYOC1v 5• Covr
from the Owner listed above) State or County License: L6 C OCP 189,0
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTfaN LIEN CAW !N'FORNATIC}N
,. _ ,
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 iONDING 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
commencing work or recording our Notice of Commencement.
0,7( AS// A a t
Sig tuYe of owner Agent/Lessee Sign ure of Cont i se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 6f- L-QCI,E COUNTY OF `J'T- I.ocle
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�day of Ckt"C. 20M by this Cl day of Cwt 2001 by
vonp,5 1-1c,W 1 t, j pv lvt�:- 3' ZQeNtn r
A)son acknowledging) (Nam )son acknowledging)
I u of Notary Public-State of Florida} Si n of Notary Public-State of Florida}
Personally own OR Produced Identification Pe o ly Known OR Produced Identification
Type of Identi 'cation Produced a of I entification Produced
:
Commission No. "es �Se I CAROLINAMAR11NEZ� COMMt5510N#EE82921 C mission No. .
NA MARTINEZ
EXPIRES:December 23,20 6 e MY COMMlSSlON#EE 829279
We
u Notary Public Unde
EXPIRES:December 23 201
3F. ..^ wridedThhu ataxy Pubtic Underwrites
Revised 07/15/2414
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