HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9�a1116 Permit Number: X601-d�d�
. ,
RECEI`. �D JAN 212016
- 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 V
PERMIT APPLICATION FOR:
�;. *'�''"7�
P Wd- E SEQ N{ 1 Q1/EM NT�OCATIOfU 'g g Y
a
Address: . 6706 Coautinca AVe Forf Pierce EL .34 q5 �
Legal Description: t_o�ke,W0e� I�a�.k Uo +' BLK 1 13 LUfi 9 (w p i,3i eq)
Property Tax ID#: !10 I ' (9 1 4 0�.67- D0d Lot No.
Site Plan Name: Block No.'
Project Name:
Setbacks Front Back: Right Side: Left Side:
y` Y�
D,E1'AILLD DECRIPi tON OF WORK ,
d+c t,� �
6+J j 2. C+"0.1 0-; C Gl"i I..7 tFIC� �r"O t/h 1+!ouse,�.
CJ co zrt - ro 18.B` e"clA Seg .'a h 0 Vie 10 Aie. oh AC.
Additional work to be performed un er t is permit–check all tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
moo .
Cost of Construction:$ 4(Do Utilities: —Sewer _Septic Building Height:
OWNER/ .ESSEE 3G�NTRACTO �
„kms.�.. .�", ._ i,�� .-�;�:�"�.�.�: x �S�wF. ,. „?. �s,�.-... .�.553;�r�.��>?.'�3.. `��`�e , y�r,.ri,* � r•��ki'�. ,;�.,�;k�T..r�-,^r
Name E1T7_g_b!t% L, 1&-AAjdAc e I W. H4 V)So rl Name:
Address: f 706 Ceaaaz Ave. Company:
City:r%Pt�c State:Ft- Address:
Zip Code: 34g5I Fax: City: State:
Phone No. 3 Z,l-2.66– 979-7 Zip Code: Fax:
E-Mail: Phe I125 95"60) yA1200 • coy'►r Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
;t LAG.ONSRUCTIOII�IEN'lA1NlORlV1J `IIU
5�PPLEMEN rA
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.l 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.
Signature of wner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDASk:Lv�, STATE OF FLORIDA
COUNTY OF `� COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisa� day of Z"'A l'N ,20NS by this day of ,20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu lic-State of Florida) (Signature of Notary Public-State of Florida)
ems"' `Personal)
Personally Known OR Produced Identification y Known OR Produced Identification
Type of Produced Identification __ '�-`a.,,,:•J Fs�,,p�N`e o -Jy.pe,of Identification
QUb��c- pec, Peb`d'uced
N°t2�`l� 4tipices 85 q6� �•
Commission No. ���� =o; �,(,eal,)I�0'm,ss°�#�a,,,,,GohiMission No. (Seal)
,,, - c tom .5a1i0n
REVIEWS FRONT MN1NG SUPERVISOR' PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014