HomeMy WebLinkAbout1606-0277.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 _/Y A6 Permit Number:
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:
Address: dp 'J'�tt'n Z& mdl�
Legal Description:
Property Tax ID #: _w ny-rro) nr -,5-
5 Lot No.
Site Plan Name:
Project Name:
Block No.
Setbacks Front Back: Right Side: Left Side:
G � k(2 7LCI- Le k ,1
d,,5-
, S 7e n 1,5- S� c s_ /r A-16) l eix
itional work to be pertormea unaer tnls permit — cnecK an tnat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
Cost of Construction: $ 2�_ �_ /� C C_�
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Name %Ao m 4 s 4 S q,,& ta, _C;w �-
Address: ci 1raln& mQ2Cefl ('1/ _
City: I-Oe4l J?'ellfl"T State:
Zip Code: &�f,5ob. Fax:
Phone No. % S- / 17e'
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: LUrt(s .So_vilmon S
Company: L5-rvtt Vc S,iSfems
kic
Address: I( IS S �- I (Cea Q ren
Dr-
r-City:
City:Vo P-7 S T U C k 'c_
State:
Zip Code: 34 �SL' Fax: 17,�
335
Phone No. 771 33,5 -3a3 2-
E -Mail: Sfig1(- Su • y C,c ) [,c-fi
State or County License: CA C 05 IR
/O S}a e
If value of construction is 2+ea'or more, a RECORDED Notice of Commencement is required.
11 Kev. //1U14
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 work or recon*Vg our Notice of Commencement.
Signature of Owner/ Agent/ lessee
Signature of Contractor License Holder
STATE OF FLORIDASTATE
COUNTY OF S 'cy(U
OF FLORIDA
COUNTY OF �f cQ-
I
The forgoing instru ent was acknowledged before me
The forgoing instr ent was acknowledged before me
this day of M -..z- 20 by
this % day of 4 20 by
0 TI��+nmvns
C�t��is SPmmcn
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State of FI da )
(Signature of Notary Public- Stat f Florida)
Personally Known _� OR Produced Identification
Type of Identification Produced �PRY.P°e, CHRISTINE B. E— NGLIS'
_ MY CO
N�� / U * )1EXPIRES: April 4,2W.
si �Q ded thio Budget Notary Benita
�fF OF F'.
Personally Known 1/ OR Produced Identification
Type of Identification Produced
MY COMMISSION a kfCommission
�Sy��� *��a,IIEXPIRES;Apfl!,!
Commission No. s `
,SlFOF FIGP B& M Thfu 9i}d9@, h
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
11 Kev. //1U14