HomeMy WebLinkAboutBuilding Permit Application jy%6- .
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SII Permit Number: WIN - O/QN
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: To Select from dropbox, click arrow at the end of line Doo(L
Address. ZZo Q�S�1l✓t Cif p.r
Legal Description: e'L-Se"in cvz;l�W_ pps-e.--i i g
Property Tax ID#: ,/�3 ZZp (p0 1 - bcl 9 - OL70 9 Lot No.
V� S
Site Plan Name: A✓e," S��j A 11 p Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
'T t aC e
Additional work to be performedunder is perm -check a appy:
0HVAC GasTank []Gas Piping _Shutters Windows/Doors
11 Electric ❑Plumbing O Sprinklers 0 Generator Roof
Total Sq. Ft of Construction: Sa. Ft.of First Floor:
Cost of Construction:$ �4 y Utilities Sewer 1-1 Septic Building Height:
Name v tr IA Name: Peter A Cafaro III �F
Address: 7Zzn 112-6�JC Company: Lowe's Home Centers, LLC
City: !4 �tsr State: Address: P.O. Box 781993
Zip Code: '_64Qc9(10 Fax: City: Odadno State:FL
Phone No. '���- 7947- 3 72 Lt Zip Code: 32878-1993 Fax:
E-Mail: Phone No. -71&-43-3 7J
Fill in fee simple Title Holder on next page(if different E-Mail: "TPC--L ee-I-`'"'h C Yr4 h"j c"
from the Owner listed above) State or County License: CGC1508417
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: , Not Applicable
Name: Name: _
Address: Address:
City: . - -- - --- - - - State City: --- -- - ---- - -----_State
Zip: - Phone: —_ Zip: Phone:
----------------
FEE SIMPLE TITLE HOLDER: -)4of Applicable BONDING COMPANY: kNot Applicable
Name: Name:
Address: Address:
City: - - ------ -- - - - City: ----- ---
Zip: -- Phone: Zip: _ -- —Phone:
OWNER/CONTRACTOR AFFIDVIT: Applicator s 'lereby made tc obtain a permit to do the work and Installation as ndicated.
cer,fy that no work or irsta!lation has commenced prior to the issuanre of a permit.
St. Lucre County makes ro representation that s grant ng a permit w 11 authorize the permit holder to build the subject structure
which s.n con,lict .v" any applicable Home Owners Assouat cn rules, bylaws or and covenants that may restrict or prohibit suc'-
structure Please cosi�u t with your Home Owners Assoc,ation and review your deed for any restrictions wh:ch may apply
rr,consideration of"ie granting of th s requested perm.t, l do hereoy agree that I will, in al.respects, perform the work
n accordance with the approved plans,the F,orida Bu:lduig codes and St Luce County Amendments
The following building Derma appl'cat:ons are exempt frcm undergoing a full concurrency rev;ew: room additions,
accessory structures,swl riming pooh,fences, wails, s,gn,, screen rnom�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 propert . A Notice of Commencement must be recorded and posted on the jobsite
before the first inspec yo intend to obtain financing, consult with lender or orney before
commencing wor recordi Notice of Commencement.
t �
STATE OF FLORI STATE OF FL RI A
COUNTY OF,.-- COUNTY OFs-:
The for ,o ng nstrumert was 4cknow!ed ed before r-ne T'�ie for[iomg:nstru nt was acknowledge b ore me
th� �ay of 23 flus Y1ay of -OLURby
Name of person a .,g,n
(Signature of Nn'at nr !ic State of F;orida ) r._.rture cf Not=.ry Pub"c-State of Florida )
Personally Known ' OR Produced tdentif,cati.-)n Personally Known._ OR Produced Identification
Igoe '.n,. inc,,t'c 1 P')n!dccd TY 1 1r-nt IF r at :i' Produced
Commfss,on Nc - (SPWI)r ommasion No —
^ P ,
Notary PuMi slur Pub;'r c r ,,:
r1/-• ,.. - oc 1 ra r Fjo"aa
txNcr.c Mar 7 ?p Ml'C L.��.:-.:
X FF 176869 fog.,y r Corr ., o EF 176869
I r�isea U `1 U " 8 , n.,l o�ai Nola y Ass 001dae Tnn : votary Assn
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUN_FR REVIEW REVIEW RFV,FW REVIEW REVIEW REVIEW
DATE - — —
RECE'VED
DATE
COMPLETED
2016-08-03 08-13 isoprt75 7722047168 >> 0 P 3/3
772-201-3513 p.8
1
iSt [
7 ;15fo j 241
8
21 i
34
$ 17
12 5
$ e 4 s
2
v
4
9
4
SAS WiG SAS C40 2 !
033S; 25i TL91; 2s C-ao
8;45GLD
(I SW) 1 FATA i
i
if S
9• $
I 12 1
12 3 S
a ;
x
\2-
a
(7a2.
2t
72Z o