HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 0"?W
RECEIVED
Building Permit Application JUN 16 2016
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772) 62-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APP I LICATION FOR:
Address: u 0 i Fite--W cd L-n.
Legal Description: 1\
hAMt*--fr_Nj0n Orr,- Lo+-Q CO-_�2 AQ Col- -
Property Tax ID#: --3,10-4- '9(9 t'e - 0(0-v -r900- Lot No. Q
Site Plan Name: - Block No._M/4
Project Name:1, (kwe -DCVff-)Mr+
Setbacks Front Back- Right Side: Left Side:
I i ke fat IiLce aftorant door.-
Additional work to be pertormed undert"i pe'rmit-check all that apply:
—Mecha ical Gas Tank Gas Piping Shutters -" Windows/Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 22. Utilities: —Sewer —Septic Building Height:
--E
Name M.
Mtot 7be
'.venDQr+ Name:
Address: 11,'01 Elcr_�� �. Company: M01 LVAzalris oc &elw dha G .'.-let-tazbw
City: fb4 Piorcr, State: FL Address: 105 lornabaw Di
Zip Code:-tiL_4ATX Fax:-Mi& City: Indi&A Aa-,bvu, (3ea_tV',_ State: F1
Phone No. (L-MIN04—A-74 Zip Code: 3Z,?37 Fax: 32.1-777- W3q
E-Mail: W/b, Phone No. 772-337-*q70
-7, r
Fill in fee simple Title Holder on next page if different E-Mail: &uk-r_5shqyn)joP. vakmo. car,,A
from the OI�ner listed above) State or County License:
If value of construction is 2500 or more,a RECORDED Notice of Commencement Is required.
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fwl "'"WR;11�0- MMOM VNimm
DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: I Address:
City: I State: City: State:
Zip: I Phone: Zip: Phone:
I '
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: —Not Applicable
Name' I Name:
Address: I Address:
City: I City:
Zip: Phone: Zip: Phone:
I
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.PI 'ase consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideratlon of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordancg 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
WARNINGITO 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 thelfirst inspection. If you intend to obtain financing, consult with lender or an attorney before
commericing work or recqfding your Notice of Comm encemen .
AIWA Lk -ALtx Zlt�
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_Signature i f Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLO IDA STATE OF FLOR DA
COUNTY 7 F - ,yn COUNTY OF 7%V
The forgoing instrument was acknowledged before me Theforgoing instrument was acknowledged before me
this day of ,>;}l f 20 �by this a day of 1Z 20 K0 by
(Name o wledging) (Name of per ackno dging)
i
( a d1n ublic-State of Florida) (Si ata blic-State of Florida)
Perso 4�OR Produced Identification Personally OR Produced Identification
Type of Iden tificati n Produced Type of Identificati n Produced
Commission No. �sfi'�I��+ eal1 BROOKESZIGETI Cofission No. ` '"'
M ,# (Seal Ro0siESztGI:Tt
* s«: Y COMMISSION N FF 249 65 ;,r_ MY G MMISSION N FF 244655
•., EXPIRES:June 25,201
I EXPIRES;June 25,2019
• is n env en ',R� •
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS I
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