HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED U
Date:_�Vol Permit Number:
' 2016
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:
PRO.P®S.ED INPRO�/EMENIT LO B ION
m , .._
Address: �I`O5� Sa,�Ta e-L&-Vz1 JRL",� �Er f(e21�- J� -3Li4'�- J
Legal Description: 146Y-E L,UOVU P+01- I-Am c t I?L.o6;K- 9:7 LQT:S /I ,,d-D 1'2-
Property
`ZProperty Tax ID#:
501 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILE°D DE�S:C I �TION�OFUUOR-K -
-ro &,-- vc v ki,,n "e
CNSTRY,UCTION LNFO,RMAO'N: 4
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 Construction: Lf�� Sq. Ft. of First Floor:
Cost of Construction: $ oa Utilities: —Sewer _Septic Building Height: f'S
OY YR "'"� • ;RI t r """ Ni9rt+kfkp fie..
� NER/LEbs SL� . : CONTRACTOR;
Name "VLAo,J )-k )Ct�ZZU Name: SrYI,('Y'J
Address: fflb,� oA' Company: ( Sr rN( rrL�1 /, '�n-Y� Lim
City: i p(e"- State:l G Address:-.7-2--1 ot.e�'DV— _ V4V 5
Zip Code: 3NJIZ1 Fax: City: li h0go'6S
tater
Phone No. 4' D S30 Zip Code:3(ict9`2, Fax: 7Z, /��k�s
E-Mail: Phone No 77.2- ZLG, PYA`]
Fill in fee simple Title Holder on next page (if different E-Mail /"v l_,zrft'L
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU�PP:LEMIENTAL CONSI"R^,11C1'ION LIE=N LAU1/ INF®RI�/IATI®N:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: NAY&vn 4CO(N OA) Name:
Address: Address:
City: ( s Iv State: '-L City: State:
Zip: 3!&571 Phone 41(,U .srS02 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 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 our property. A Notice of Commencement must be �recoa7cl posted on the jobsite
before the firstiq/arr7c n. If you intend to obtain financing, consultr an attorney before
commenci ordin our Notice of Commencement.
Signature of O r/Lessee/Contractor as Agent for Owner Si nature 6f-Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF :S-Y• COUNTY OF -5k'. '1...»� �
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this —c)- day of !�! 20by this a day of qt_'� ,20A!5_ by
-1 -_V\ Ce. Q�
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu ic-State of Florida) (Signature of Notary P blit-State of Florida)
Personally Known _OR Produced Identifican . Personally"Known OR Produced Identification;,
Type of Identification n� �Na r�IVENs Type of Identification NNA 91VENS
Produced D`AN State of FIOS+p produced DEA
PIIQ' ota�Y Public Dec 16 21 101WV Public State ot161o2016
w N ExPlces 876 x + es Dec
Commission No. 5$�� `��•e°` N,( )m #EE 85 s noommission No. S�1 Nty Com e ) EE 858761
GOmm+sslhNahonalptotaty?�r a �¢o, m s+ ztionalN A
Com +s otaty ssn.
REVIEWS FRONT `Z-ONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
1-e-v-7. 7/2014