HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED pp ff ,n
Date: iC J�yl�- 1(0 w 2-01 Permit Number. l 7 �
F3 E
Building Permit Application JUN 2 0 2016
Planning and Development Services
Building and Code Regulation Division FEW01TTiNGSt. Lucie (:aunt f=
2300 Virginia Avenue,Fort Pierce FL 34982 Y, L
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential c/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 2WO S , C/emy-\ Dr'W(z. , t)n 1-yak Jens M1XX `
Legal Description: \mac Yl Cl COO& U n is -
Property Tax ID#: ° so oa— (CC)2- — 00 2-s--000 a Lot No.
Site Plan Name: ` - 01 Block No.
Project Name: S I�:[ C L C1 CD r)6
Setbacks Front — Back: Right Side: — Left Side:
DETAILED DESCRIPTION OF WORK:
Lf C�o��e �i-�.�i� C�vri-I.-z.�.� �-r� �-r�e�f` ��� c-�.n.�l .r4�f�► 12- Wit?
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit-c ec a appy:
E1HVAC E]Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 1:1 Plumbing Sprinklers I Generator 1:1 Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ /9/)17 Utilities:Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name - ` Name: SZCZ REZ � 's-
Address: ! Company: 6\" ��eC-�-we- L>_�
City:��Y1S'e Y) -y�)CCV�O State:_0 Address:r XfS'}01k"1 1hr
Zi Code: n
p c�� ��cS� Fax: City: L vUe- Stater
Phone NcH& Q 2 _2_ Zip Code: `_5z-1a?5S Fax: -770.--
E-Mail: -- Phone No. 77a-^yZ'J-x.001
Fill in fee si ple Title Holder on next page(if different E-Mail: Gk/p F)aCA-dC � -t-e'(UE�
from the Owner listed above) State or County License: E, J301 N y9�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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'SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAG C MPANY• _Not A p able
Name: Name: W
Address: Address: D .
City: State: City: I Ila -1W Y. 1 State:
Zip: Phone: Zip:f�7 Imo_Phone: /-gC2C2= y
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 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 recording our Notice of Commencement.
� s
_Signature of Owner/Lessee/Agent n r of o ctor/License Holder
C .,
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF s4 LVCI 'C. COUNTY OF ,-- •uiC,IN,
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of t/(1n r 20/
by this M day of-r!U uE ,20 j�by
(Name of person acknowledging) (Name of person acknowledging)
2/"17_tr1'f Ah , ' —___
A" V J(,- �e&q A, 1 ,a ! L� ,�,
(Signature of Notary Public-State of Flori ) (Signature of Notary Public-State of Florida)
Personally Known , ' ro1GER Personally Known OR Produced Identification
Type of Identification d e' = MY COMMISSION M FF94P.Wg Type of Identification Produced .� 0.
EXPIRES March 21,2020
Commission No.:3 Commission No.� Seal
.FR* KAREN S. NIELSEN
F 11,637
i9/F 0�{l00.`O`�: MY Commission Expires
Revised 07/15/2014 June 12, 2078
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS