HomeMy WebLinkAboutBuilding Permit Application I
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
I qDate: �" �'� Permit Number: 1t0 A' ODI
RECEIVED
- �4UG / 1 2096
Building Permit Applicatio
Planning and Development Services
Building and Code Regulation Division
2300 Virginia�Avenue,Fort Pierce FL 34982
Phone: (77 )462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: ��� t'J
PRQPOSED IN'P"RFU EMENL®CATIONyg .j . r ` �
r,a,
Address: 7' �l
Legal Descripi ion: J&- 3 ,/f/W 24. L---1 A2 R 41'3 . e4 24- ��- l Z
C 3y/7 2.r & P- 76'
-/-t/�z�G
Property Taxi D#: 311 — Xs"— 00 O — Lot No.
Site Plan Na e: �U,¢N Llie!��� Block No.
Project Name':Ch�N we//Gf
Setbacks Firont Back: Right Side: Left Side:
D'ETAI'LS® ®E-�SCRIF�fION�C�?F U1/ORK:-
�rnaI&IIale-er__ 11410�'0'rT wi7L� /� IG tiefoXc .5
/ 'nwa A1*2.c.w
C®�NSTRUC�TIfJ N INFO�R�MATL�ONk� ,�,�.4� � � ,
Additional for to a per Orme un er this permit-check a that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric —Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: /4*2 C Sq. Ft.of First Floor:
Cost of Construction: $ II t'o4'�''� ^ Utilities: _Sewer _Septic Building Height:
®war
RRL�ESSEE:
Name e L4¢ Vlel cs r Name: e'o ""� s a o ►J'
Address: &s 7416 /�1-7ira Company
City:/-01A Z.,CiC_ State:/L, Address: 3y2-S
Zip Code:3 41'; S7 Fax: City: A' e,4 State:_/_I
Phone No. Zip Code: y�7� Fax:
E-Mail: Phone No 77P -02��
Fill in fee sample Title Holder on next page (if different E-Mail Cha tit r,-, t���s 6-i„
from the Owner listed above) State or County License CSC CiO.�cio'7
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: 1 Address:
City: I State: City: State:
Zip: Phone Zip: Phone:
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FEE SiMP k TITLE HOLDER: —Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: I Address:
City: I City:
Zip: 1 Phone: Zip: Phone:
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OWNER/CONTRACTOR AFFIDViT:Application is hereby made to obtain a permit to do the work and installation as indicated.
1 certify'that i o work or installation has commenced prior to the issuance of a permit.
St.Lucie Coun makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in cc lict 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 w� ilding 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 the4crbsite
before the first ins ction. If you intend to obtain financing, consult with lender or an attorney fore
commencin wo or recgeding your-Nolke of Commencemen
CM ignature o�',90er Lessee/Contractor as Agent for Owner ignature of Co actor/L cense Holder ' N� s
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U a7 O d Z
STATE OF FLO &0�e
�` STATE OF FLORID _�
COUNTY OF rti COUNTY OF i�i- .��-- U`� C Z
< v x o
U a LU y
The fAgoing instru ent was acknowledged before me The forgoing instrument was acknowledged efor E
this P" day of!t,a '� 20/( by this O'rday of `��f ,20 � Y a
L CowBAN
(Name of perso a P a.- ° fxFtres FF p7ZO 9883 (Name of person acknowledging �` 4
y Comm.
mmtsstoo 311onN Notary Assn.
OF iti0
�4'
(Signature of Notary Public-Stat orida) (Signa ure of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known Produced Identification
Type of Identification i Type of Identification
Produced I Produced
Commission No. (Seal) Commission No. { ApN
tytGK`t "State ot2%;Ava
of 01
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGE _+`gay ug+ • mTLE .a 9 SN
COUNTER REVIEW REVIEW REVIEW REV[ PY
RE ,. wl IEW
DATE �''•�°;
RECEIVED
DATE
COMPLETED,
ev.