HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEI`.'rD A'15 0 12016
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 V
PERMIT APPLICATION FOR:
PR®,P®S`ED INP�ROENT LOCA#TION.:
.s.6mrp M.�,n.fi: ,,, y §.aa.i•u _
Address: Cd2t1 2y OI,�' f'-_o;-j- fi e4-Ce Z'54992-- -7-
Legal Description:
PropertyTax ID#: 'y�Cjaa r Lot No.
Site Plan Name: Block No.
Project Name: -'F�tTo cha9a7Lb
Setbacks Front Back: Right Side: Left Side:
DETAI'I.ED D �SCRIPTION.-OF V1/0 IC
y l 7/�/!' r o6 Ll Qi Com/V� D1/ ZL
CONSTR'IJCTION INF fi
0,141161111,1111111''1 1 IN R
Additional work to be pertormed under this permit-check all that appy:
_Mechanical ^Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Cobstruction: Sq. Ft.of First Floor:
Cost of Construction:$ { .8 Uo Utilities: —Sewer —Septic Building Height:
OUVNER/LES 7 : MEN ST
Name � 0� - I Name: 7F af-ex .5
Address:c L4L(.Z b Company:J. 6- V'S Cm i UC
City: Q06''4 �"� �i State._ Address: ��r� I U
Zip Code:3 U5'4-. 1...U-S-JC-. State:
5 Fax: :'City ] r,
Phone No. o� , ci I o, S-7 Zip Code: W-��o Fax:
E-Mail: . C_ 0) AK 1600 kA ®&L� Phone No (3'7L, / —Z?6�
Fill in fee simpl itle Holder on next page(if different E-Mail VCj-e/gj3Kgo a
from the Owner listed above) State or County License CGC I S0804-4- 3
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
5"11F'PLEMENT'..�L CO'NSI'R�UCTI®N L1�EN LAUV IN�®R�IVIAI'[®;N:
DESIGN E ENGIN R _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:- C-�J -►,LS Name:
Address' _ 0 . 0,6137 Address:
City' u .-2 State: ZlL City: State:
Zip: Phone 7 Z-3 6 i"Z` L 54 Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name: I
Address: Address:
City: City: If
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 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 Commence nt.
r,L,-co
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. ature of Owner/Lessee/Contractor as Agent for Owner ture of Contractor/License Holder
STATE OF FLORIDA. i STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledgq�before me
this \ day of V 20� by this \ day of J� 120 by
J d
?S 0, 1�5 L� a"N
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary blic-State of Florida = (Signature of Notary blic-State of Florida )
Personally Known OR - -66604tltl`e #� �166 Personally Known 0 P.oduc _,4A24 ` tion
Type of Identificatio. t p„buC ec 16.20 Type of Identifica'l-lo7t�'�'s � DEANNA a
Produced s�;�, lAotaN Expires EE 858761 L`� �.uY1P�e(i'. No, Public State of Florida
Produced
1 ; Dora fission# Nssn• �', Comm. ices Dec 16,
r m hPtatwnatNotary k�=`� .=My #EE 858761
Commission No. a �= ,�'? ded1% Commission No. ) Commissihq ��Notary Assn.
of e�°•` Bonded[hroU9 p
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Te—v.7/2014