HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l���� Permit Number: ��a$"01�1 5
s J_ RECEP.'D AUG 18 2016
e _
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300.Virginia Avenue,.Fort Pierce FL 34982
Phone::(772)462.1553 Fax: (:772)462-1578 Commercial Residential /�C
PERMIT APPLICATION FOR: To SelecHrom dropbox, click arrow at the end of IineS�00, �S
PROPOSED IMPROVEMENT,LOCATION:
Address: CFO II Ca)�a 1140
Legal Description: 3 33 3g NLXJ 11q OF Su'J e12/- LESS CTVfal_. 1211'✓ SND LG 5,5
(ZeSIO ZVITi DIV 1r7 -182- b Casu)i n O 6:-%f-4 j - C3,9_ e6 fi e- 1, b elz0 7(12- SF')
PropertyTaxlD#: aa03 -/n3�1 -0001 - 000 -Z COl°b�- 1)-73'.34-Lot No.
Site Plan Name: 1 1 0 0 Block No.
Project Name: OL SCt. 1 i Y7 0
Setbacks _Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�0s 'F/�-Lt-A--,- ; 0W v F SEV&1v 67) l�cs04J'I CEJ
5 c�"7T 6Z. S - 11J► n rZN 0 w.5 O N L'Y.
CONSTRUCTION INFORMATION:
Additional work to be nerformed under this permit-c ec a appy:
IV I
❑HVAC Gas Tank ❑Gas Piping Inj_Shutters ❑Windows/Doors
❑Electric ❑ Plumbing ❑Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ a, 7. 2 3 Utilities. Sewer❑Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 1"`o"r C'cz5 Name: ori �a�S
Address: 90) a.Sa i nvp r Company: Dvr A_K)Y?'75 .�.
City: JF0 Y k Ri ell'C9_ State: _0 Address: 1 o o N 14 -�w
Zip Code: 3�ng5- Fax: 1 City: IF t e 0- State: y
Phone No. 77 — Ll-1 S— -7-710 Zip Code: 3LIOLS Fax: -7-72-_294-19 �0
E-Mail: b44 Cy`a,Y A?,Rr-S aV750 . rp inl Phone No. 777- 701Li- IEV
Fill in fee simple Title Holder on next page(if different E-Mail: dAhuy-ri Caoe S\Gu.At�e✓'S i ►71'@ D
from the Owner listed above) State or County License: C!' 3 c1 y
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: _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 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�recordin our Notice of Commencement.
11'���' 1 0 —
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S �-, L-0c $ COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this \-A� day of—StL � 20 Lby this S`6 day of Uq 20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pub' -State of Florida) (Signature of Notaryublic-State of Florida)
Personally Known OR Produce (� rEbiff i� tda Personally Known 90R,Proud ced=d �B s-�
Type of Identification Produced' l9 ` State o 20 6 Type of Identification'P p.du4ed � ' a i Florida
<;•��=����,, otar`1 ° xPlresDe 95a�61 :.�,;�p�:a�?�, row
,, oires Dec 16,
Commission No. Comm• I r EE Ps5° Commission No. Jil b m. � )EE S5g761
.[S f, Notary .s.
-.•,• ��.• m nal .,v� �, -q _ Commis Assn.
Bonded Through National Notary
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Revised 07/15/20]:4 y
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DATE
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INITIALS