HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST1 BE COMPLETED FOR APPLICATION TO BE ACCEPTED )
Date: Of ' c�• �U " Permit Number: / �C ` vV ',
2216M RECEOVED.
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Building Permit Application FEB 2 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: G,0,
s
PRQPOSED I � LOCATION `
Address:X-®(a AV. C°OCOrI44 All,&
Legal Description:
PropertyTaxlD#: �� �g �`� "' �f� �V��Q`" (p Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left,Side:
DETAILED,DESCRIPTION O WORK 2
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VA ve 6 -r o w-
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itional work to be pertormed under this permit-check allthat 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:$ Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE.
CONTRACTOR , .
._
o.
Name ...J 00,heE e Name': b
-Address::„�oQli. Coe.,_-NnL+ Nde Company:;, o -.CXd4.•:' �t�;RS�rIJI d
City:,:'.. P%-t?c"� 6z ✓
9L
State: — Address: /7�/l 5�.� /' n Jersorx S�
Zip Code: -54q SZ Fax: City: 125•x- State: )CZ
-
Zip
No. "2 Cz(4;,0 651 Zip Code: 5 Fax:
E-Mail: Phone No. `� Z ' 30-26015'
Fill in fee simple Title Holder on next page (if different E-Mail: D e,'PS06
from the Owner listed above) State or County License: C l.G _2_q6 6eD
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPfP`LEM,ENTAL CQNSTRUCTION LIEN LAW INFORMATION
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 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 Comm enceme t.
e 1 A, ¢1 to ' L /1- Db7.vL't-tL
Signa re f Owner/Agent/Lessee Signatre7LO
tractor/License Holder
STAT F FLO A ` . . STAT;ORI
COUNTY OF_ �. Mit.�n COUNTY OF
The forgoing instryqiept was acknowledged before me The forgoing inst,ru t was acknowledged before me
this day of `rV ' 2011 by this day of VTLO 20J 0 by
(Name of person acknowledging) (Name of person a�wledging)
(Signature of Notary Public-State of Florida) (Si ature of Iftary Public-State of Florida )
Personally Known OR Produced Identification L Personally Known OR Produced Identification
Type of Identification Produced W jc&ebMAJ pTAHpA of Identification Produced Y1yey- kret))-e_
NOTARY PUBLIC �1 ZARY MELISSA JUDITH P�
Commission No.FI=t�G���la- a STATE OF FLORID Commission Noa d��o�C1r} NOTARYPUBLIC
ow: �?Comm#FF096192 W -'STATE OF FLORI
Fvnires 91251201 i,
M*FF006192-
e � Expir y
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MAK"at�E�Dt
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. /2014