HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: s1�a 1Co Permit Number: %43 S-Ol"1 O
s RECEIVED MAY 10 2016
Building Permit Application
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: V,,.c ty' CN. a
PRPOSED INPR®uE; T L®CAT'I�
Address: 660,)-- `l'
- P �`�Dyrt ctr P IS W : Pi e-ru , FL
Legal Description: td r e� e-�h&nq 2 Dot c Vn '-;?S 2a' oil (`
Property Tax ID#: \'J>a G,5 _ O �3� Id6- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE 11 BLED DEMSCRIPTI®N.®F 1N0 =K:
C--- Chevy .z 01,11— e-dFide-0sev only
C®'NS�TR'tJCTION I�NF®R�11/IAT'I®N:
Additional work to be pertormed under tis permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction:
lSq. Ft. of First Floor:
�/
Cost of Construction: $ ! '9 Utilities: —Sewer _Septic Building Height:
.,,...ten� ��.� ti., -
®�WN;ER/.�E�SSEE: CONT RAC1'OR:
Name I L I C-0'I re,V1 Name: rum duh
Address: 66o,)- pallm-&-r Company: Gt2 L "uhT° il, ItiG
City: t" 1 State:�l_ Address:
Zip Code: �I i ��r Fax: City: .S L-: State: L.
Phone No. Zip Code: Fax:
E-Mail: Phone No 7�l �- � �b3a
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License C-A t- t 9f f'7? 3S-
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SII+PPLEIUIENT'A�L CQN'STRf.UC�+TION L.I�EN L.A�`tt! I'NF®RM/�1"ION:
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 rk or recording our Notice of Commencement. 117
_A5/
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor Licens Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF e,-Y- l.ye �� COUNTY OF 6'-t- 1.-1C i-R
The forgoing instrument was acknowledged before me The forgoing instrument was acknowled ed before me
�
thisXb day of 'M 0.`E 20by this day of Mai 20p by
o w. v� k Vn. `. `k'o,n
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary blic-State of Florida ) (Signature of Notary P blic-State of Florida)
Personally Known OR ProdLm ` I 'itiy Fi 6� 20� Personally Known_.QR ro I eiattfi�
Type of Identification oP�b��p��es��g50�6 FssP Type of Identificatio u Notacy �ces�eo,6�61
Produced L rue,' N omm' foo# a�Nota�l i Produced FAL �4:x m.Exp #NE
pssn,.
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o. J*•� Gom ou9hN - � _ - Gotnm�s hNaC�ona�N
Commission No. EE�5 '. �'_ (S���j. Commission No.'s �, ` �o edZhtou9
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
. 7/2014