HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: kiz Permit Number: Vz O �r 6 3 41
RECEI .�D JAN 2 5 2016
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 .W',4V\01z 00 f
PROPOSED IMPROVEMENT LOCATION:
Address: I q q,0 1f IAl in/ I L1) 0 LI V C d;r'
Legal Description: 4 4 Z-o- kI - D 0 1 - 0 0 0 -
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
2-EPu4e—Pr E:Y_I S'r10 fo Allele/ I WI PNCT-'00OR f.
CONSTRUCTION INFORMATION:
Additional work toe ne rmed under this permit-check all that appy:
HVAC 0 Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers ElGenerator FIRoof
Total Sq. Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction 0-2 Utilities:Sewer 0 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name.4�O2QyOf�A r�-r' ��f S� Name: l� 0 4LI06
Address / q--QQ tv ILO 0 L4 V&-e-' 7-, Company: CLL j3 I LO&Ad
City: P-ALtm State: Address: f 1 1 f L5J _ aV 3&`7 L," P .flD
Zip Code: S QO Fax: City: 5'ruw-MT- State: FL-
P hon erN-UWW "� � �l<,o ? Zip Code: 34G5� Fax: zz1 - 3Z�3
E-Mail: Phone No. 2 I
Fill in fee"simple Title Holder on next page(if different E-Mail: 2L 4 4 Ai(-v" Q f4 r-rl"1411- . Loa k,,
from the Owner listed above) State or County License: e sc_ 12-S-9- 6�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN ER/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 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, cons it wit lender or an attorney before
commencingwo or recording our Notice of Commencement.
'ICNL. 4 AN A s
Signatur,-.of " r/Lessee/ gen Signature of Contra or/License Holder
5.
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF U� \'� COUNTYOF
The forgoing instmment was acknowledg d before me The forgoing instrument was acknowledged before me
this$5 day of (Jc r V\ 20by thisaaday of o , 20((by
(Name of person acknowl dging) (Name of person acknowl dging)
(Signature of Notary P lic-State of Florida) 'gnature of Notary Public-S to of Florida)
P.�G't ts3' r° � mss:a�G,"*.� ssanc^
Personally Known OR PrpcuGdMenti i ,RFJF�CtiIUJ�IS Per onally Known OR Produced Identification
Type of Identification Procluded, " c to Jly l"e of Identification Produced AW
\; �, My Comm.Expires Dec 16, 016 r
Commission No. � s� ,t, rbc(Seal�mmission#EE 8587 1 Co mission No. F
Through National Notary ssn. ? ,,..�yP•P•� DANIELLE CARNEY
° ,,� �a�•,,
l.� ftio �y1 c . Notary Public-State of Flo,, :
• ••: Commission#FF 899125
Revised 07/15/2014 '••';FOFF`a;°,' May C�o�m�mpinu2 9
119onill Notary A n.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS