HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Ct� 2nlko Permit Number:
E C E1rg
Building Permit Application MAY 2 6 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: To Select from dropbox, click arrow at the end of line Laa� � �� 1
PROPOSED IMPROVEMENT LOCATION:
Address: VP 0 OCa S't 'FOC k'eJ f_ 3(Aq 8 2
Legal Description:W bjAQ Citt-,A S(() 110 -5 W L Q (;rD ww c r 0.P Lt+ 230
Property Tax ID#: NO3- QRZ q ID' M ' q Lot No.
Site Plan Name: Block No.
/�
Project Name: l„ Gk S S(Y)
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
9-twove, ex MiV j ng to dec)41 re nc�kk CXr_0 'to C-13&0 I'\n s+0_U Ine)w
P A S vk oL, ;�n s�a�•l n e w irk rood' 5V klanti Z U g SVA+
,3S S�Iz o cin SJ`rte-1_ IsFE,s ILL)1►0� t >Jo4 lb-pS-13
arCo e W ?A-S U0 �Fk_ 104 c,D4-1 FL r-1 q tP
[CONSTRUCTION' INFORMATION:
Additional work toe nertormed under tispermit—check a appy:
❑HVAC. .. . Gas Tank [:]Gas Piping. �$hutters.. ❑Windows/Doo.rs .
Electric Plumbing Sprinklers.
rinklers. . . .' Generator ., Roof
El, g p .. . ., LI
Total Sq.`Ft of ton struction:. DIDS . Ft. 'f First Floor:
Cost of Construction:$ 19 ZQQ Utilities: Sewer❑Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: Let, D1Y)fXAYX-4
Address: Company:fiaTclQtil �t7 LI.0
City: C- Stater Address: `�S
Zip Code:'jLAQ&2 Fax: City: y M?a�O 1 Stater
Phone No. h�_31�-�'�nb Zip Code:J'32q\dl Fax:
E-Mail:`MAf'r 0% 1Le @ 011Y ati. cowl Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:c3DY110L @_,G-.ee(AOMrpo44s•cc"
from the Owner listed above) State or County License: LCC 133 OG CSO
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: )CNot Applicable
Name: PL Cr\Q11f\ '`i(\(,I JQf-}XN 1 Name:
Address: 7 0 S'w 134h Avg Address:
City: l cmymoa Qx h State:
_�� City: State:
Zip:3 0t;Ct Phone: lob-Z 8 l-(�8 0 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 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 Commencement.
S
_Signatu of Owner/Lessee/A nt Signature o ontractor/License of er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF V?�C, COUNTY OF C'
The fo oing ins r ment was acknowledg d before me The Nday
ing instrument was acknowledged before me
this i day of 20�b by this of 201 t�o by
Invi _ `
(Name of person acknowled i%*'rj,*= SONIA DESfAFNI�a e of person acknowleilt
*_•; ,,,
SONIA DES7AFNEY
MY COMMISSION#FF12 5420 MY COMMISSION#FF125420
'•.,,�ioF oP. EXPIRES May 21, 2 1 %1..............: EXPIRES May 21, 2018
OF P,.•
(Sig ature o ry P ✓ Oc- a e o _ ori a gn ure of to blies
Personally Known '."/OR Produced Identification Personally Known / R Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
L
PLETE
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