HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `
Date- �� Permit Number: /�
RECEIVE®
guildin Permit A Iicatio
g pp LIAR 2 3 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:
PROPOSED'INPROVEMENT LOCATION 3
y .,
x
Address: 5560 OGl ll-t_ L—CACA h1yC�i :�� �Q�rc FL
Legal Description:J3013L, AD -5W,/LA OF SW /4 Ie 1 a.,A o t .�—p I np
l a^ca -353 -R ur, 5 Li Lo- - &t
Property Tax ID# P Lot No.
Site Plan Name: I//77cd Rm w fy Block No.
Project Name: P111 eQ ,n,�u,
Setbacks Front_ Back: �/I Right:5ide: Left Side:
DETAILED DESCRIPTION OF K.
-- - +
Vj
g �
CO:IUSTRUCTIQN I(VFORMATIDN " `
e _
Additional
workto ._be-pertormed under this permit—check all that appy:
_Mechanical -Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator v Roof
Total Sq. Ft of Construction: (,905oj Sq. Ft.of First Floor: NX
Cost of Construction: $ "I O0 Utilities: %Sewer XSeptic Building Height: X
ri OWN:ER/ E S ..E . " ' CONTRACTOR
;,,Karn -RIP 147N Name: y—S
�r�;i4cls {e5 : ati��r;. e Company:
th. A
c .'City'-6. '�Ii"!l (�� �,,... . State: Address: �t�. �75��
ma
o
prCa Fax! N/,A City:" -f- State:
'"' •
Phone No. 14 IN Zip Code: -]�( Fax: 11 7_-gB'9-(o050$
E-Mail: Phone No O 1—I5
Fill in fee simple Title Holder on next page (if different E-Mail 1 V, r t C.An"
from the Owner listed above) State or County License 1�
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: _Not A ableMORTGAGE COMPANY: _N #applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Applicable BONDING COMPANY: Not A ramble
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 ma result ur in-yoging twice for
improvements to your property. A Notice of Commencement mus`f be recor ed'and poste on the jobsite
before the first inspection. If you intend to obtain financing, consult it girder or an attorney before
commencing work or recording our Notice of Commencement.
)Ail&` eE_(J/r
2.
naturep f/b caner/-- ssee/Agent Sin ur -
Cohtrac 1ns ober
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 6T . UCCI f- COUNTY OF 5-t • ��—
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisday of {�'f��(I ,20L�by this�day of RCLCc l— ,201 to by
fiT/l V 1'h
(Name of person acknowledging) (Name of person acknowledge )
(Signature of Notary Pu "c-State of Florida) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificati n , Type of Identification
Produced s Produced i-Upt. C_k43
'�NTHIA BAKER �`� ' RACHEL TAMARA VILLARUE
/ Po1Y COwIM[SSION#FF231810
Commission No. X02 9! ¢t£eaf)s:hme29,zo19 Commission No. F F � # IW9•State of Flow a
a+1� z€ COegnlNlon#�FF 91912
'• r•` Mr Comm.Expires Jan t p
REVIEWS FRONT ZONING. 'SUPERVISOR PLANS VEGETATION SEA TURTLE IVIANGROVL
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014