HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Z
Date: /" �1` ( Permit Number: 03
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Building Permit Application JAN 2 7 2016
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:
PRORO ED INP'RaAEMENT INFAMOU
Address: t)OZ lFi Ila 15r(j u , r6r-. O r ge 4'L 3ggga
Legal Description: d` _ 2
4'7 S-
Property Tax ID#: 40a,`(Oo2.-00(06-000 -q Lot No. S a Ila
Site Plan Name: 140A-0-in, f244ow+ v- Block No. _
Project Name: �l V.
Setbacks Front lJ Back: Right Side: Left Side:
DETAILED�PTI®N OF WORK:
I �/f, e� I-
,awl `� clI r,F g1lnia�n QQ�lyiia,I� C� ,n. Qnp i11n r(u� lll.li���s 4 ,t
(d ROIL
CONSTRUCT ON INFOR+IUTATION:
Additional work to be performed 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: $ 4�HtV�91 Utilities: —Sewer —Septic Building Height:
OUV'NER/LES�SEkE: CONTRA_ Cl"®R;
Name /1Aeul+6y� Name:
Address: Sbp!% Company:
City: 'O-L4 �i.Q rc� State:� Address: (QSo "6 P.(�c.`i aur Auunoc
Zip Code:X45 %A Fax: City: Pea+ 4f . Citi State: rt-
Phone No.'91 a. 536-0205 Zip Code: 2LI j ss3 Fax: n i I A
E-Mail: )IA Phone No n)a,.a4b-7,44-7
Fill in fee simple Title Holder on next page(if different E-Mail eln ,.�,�'�,•r�o',,�r��wia ��Corn
from the Owner listed above) State or County License 'a.N?S
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
PLEMENTAL C®NSTftUCTION LIEN LAUV I' 'FOR�MATIaN:
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 1-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 ancing, consult with lender or an attorney b
co mencin work or re rdin our Notic l ;gym encement. i'`•':Ho.
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Signature o Owner/Lesse Agent W m<a Signature o t /L ense Holder a x_
Coco Iwo
Mir
STATE OF FLORIDA o WK< STATE OF FLORIDA min j
COUNTY OF ��'m COUNTY OF
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The fo oing instrume was acknowledged before oA The forgoing instr nt was acknowledged befr
this day of r 20A by 8!N thi�day of 20 17 by a;N
�,�-��r��?� ���'►��- �/ ����-Jd�I.��D�1 ����')')�Oil '
(Name of person acknowledging) (Name of person acknowledging)
(Signature of to Public-State of Flo da ) (Signature of N ry Public-State of Flo da )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.