HomeMy WebLinkAboutBuilding Permit Application 02/04/2016 11:22 FAX 1a001/003
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATI0114 TO BE ACCEPTED r ''
Date: . i Permit Number: , C),
- Building Perm. $tApplication RECEIVE =
Planning and Development Services FES ® 4 2016
Building and Code Regulation Division f
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commdreial Residential _
PERMIT APPLICATION FOR: To Select from dropbpx, click arrow at the end of line
Address: -7 61 Lo K&S &i- POC-- Zkh 14_.,.1,e. 3t KS a
Legal Description: 2AYe-C 9,.,r k - t_k. -Lq- (a•(-2=4 [ rkC. 223 6C 7_967-Z
Property Tax ID#: Li 1!q S - b 19-9 en4n -(o Lot No. V4 _
Site Plan Name: Block No._�.�•
Project Name:
Setbacks Front Back: Right Side: Left Side:
t r. Cac o�k r
MOP.#-
Additional work to flas
orme un er t is permit-c ec a appy:
HVAC Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric Plumbing ❑Sprinklers Generator 0 Roof
Total Sq. Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ Qq• LltilitiestnSewer Septic Building Height:
Name Name: 0
Address: 76 1 Lon& s 151- ____ Company: �, P.itn fir,.►.. ,
City: a r s-1- L.JciP State: :Address: % W 30vkh V
Zip Code:�3QASra Fax: :City: Qt7r�r S�'•1-an�Q.. State:-T--\-
Phone No._:h2- (7?8- 7J'7 Zip Code: !>4 Q\%4
311-011 Ci ti
E-Mail: Phone No. �.�
Fill in fee simple Title Holder on next page(if different
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
02/04/2016 11:22 FAX CC7i002/003
DESIGNER/ENGINEER: Not Applicable .MORTGAGE COMPANY: _Not Applicable
Name: (Name:
Address: Address:
City: State: tyZips Phone• �ii
p: Phone:
FEE SIMPLE TITLE HOLDER: —Not Applicable ,80'NDING COMPANY: _Not Applicable
Name: . Name:
Address: Address:
City: ;City:
Zip: Phone: f 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�y III authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association I•t,1es,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 here4V agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes a)rid'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 rdoms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Qommencement 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 f you intend to obtain financ'ng,consult with lender or an attorney before
commencing work or n ur Notice of Commen .ement.
ature of O er/ rit/L ee a u o contractor/License H der
STATE OF FLORIDA TATE OF FLORIDA
COUNTY OF. COUNTY OF
The fo'rPoing instrument s acnowledgerl hefore me The forgoing instrumen as cknowledged before me
this day of 20 �d`by this day of 20/6 by
(Name of person acknowledging) Name of person acknowledging)
(Si at a of Notary Oil-State of Florida) (Signature of tary PublicIR
to of Florida)
Personally Known uce en t ca.Ion liertonally Known� Produced Identification
Type of Identifica orl?i3rp1 d LESLI D ZELAYALESLI D ZELAYA type of Identification P
MY COMMISSION#FF165172
.�. �' EXPIRES f5t t er 1,2018 Commission No. t,,X s- LE ZELAYA
Commission No. +�` ''P. MY CO ON#FF165172
(407)398.0153 FlorlcimotaryServlce.com ' °+
'•°E �.= EXPIRES October i,2018
(aa7)aseAt53 FlorldallotaryServlce.com
Revised 07/15/2014
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