HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - Permit Number:
RECEOVED
Building Permit Application FEB ®4 2096
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
PROPOSED IMPRO
0
UEMENTjLOCATIN
w. .... ,.,_ .^
Address: ,0004 s ocepry On ku
Legal Description: Sa witios nomoO 6'D ✓t- zo
Property Tax ID#: 2{�2 - [504 -c�u'db -000 5-010— Lot No.
Site Plan Name: W*t--s%+ Block No.
Project Name: wort'S %A-
Setbacks Front Back: Right Side: Left Side:
DETAILED QESCRIPTION OF,WORK � ,.:., s y mom ;
CONSTRUCTION'INFORM'TIO'N
� s
Additional work to be
0 nertormed under this permit-check appy:
Gas Piping Shutters
or's N Windows/Doors
..i_n_do_w. s/._D...o,o.r.s❑HVAC ]Gas Tank F
11
Electric Plumbing Sprinklers _ enerator _
�Roof
Total Sq. Ft of Construction: SFt.of First Floor:
c'37
Cost of Construction:$ 1��� Utilities: _Sewer Septic Building Height:
O.VI/NER/LESS_
EE CONTRACTOR
Name�yAl�Sl- Q (.E31I1.~td ln+6 Name: AA icgAj=�_ ,
Address: 9 a(a246, oljk and - ,Q,Q Company: tA1Sti7�1 �- t (.tM(evgel
City: P-to5t• 1 IQ State:N`1 Address: 0ZL> M-) G6n -rl-4
Zip Code: 41* 1113 Fax: ��Z '�? City: S�v A-t^r- Stater_
Phone No. a'LQi g 2r'7 Zip Code: (Y Fax:__(,"i2 ,S7KN
E-Mail: Phone No. (,1 C1 Z__ OCTA J
Fill in fee simple Title Holder on next page(if different E-Mail: lG/ _ vl-iN
from the Owner listed above) State or County License: `Z--
r �
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. ��
SUPPLEMENTAL CONSTRIJCTiON LIEN lAW ENFORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Ste.J1-01 cr c3t o-'N e�_ R6 Name:
Address: 59-6 Sa- filar-Vn Sdtlr� 1 0's Address:
City: State: rL City: State:
Zip: 33-1LOD Phone: "):4 '1c'iboc> 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 thepermit 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! 'lure to Record a Notice of Commencement may result in your paying tvfflte for
improvements to your pro Ort .A Notice of Commencement must a recorded and pqrsfed on a jobsite
before the first inspe ti If u intend to obtain financing, con t ith len r or for before
comme Work r our Notice of Commenceme
s
_Sign ture of Owner/LesV
Sign ure of Contractor/Licens Holder
STATE OF FLORIDA STATE OF FLORIDA rCOUNTY OF COUNTY OF �I /x�
The for ing instru was acknowledged before me The fo�g�g instrum ntiwg acknowledged before me
this. d of t?t)92,9 20 LLby this day o Utah 20 & by
d6LLSC-)IO
(Name per cknowledging) (Name of rson ckn wledging)
V y
(Signature o Notary Publi State of Flor' ( ignature of otary Publi,'tate of Flori
P sonally Kn wn OR Produced I ationf Persona o OR Produced Id ific tion
Type Id ificattiion Produced Type of Identification Produced /
Commission No.7 / Commission No.1 / L (Seal
.``pr'o""'•• JOHN LEE TINNEY
"a'P'��. JOHN LEE TINNEY
'•* *•_ Notary Public-State of Florida
My Comm.Expires Nov 15,2018 •. •iE WA
My Comm.Expires Nov 15,2018
NM()r11d Not
Revised 07/15/201 -;;� oFF`oP�•` Commission#FF 165316Commission#FF 165316
������1�••• Baidedthrou NatImalNot Assn. „OF��•���
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGR VE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS