HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10_21L4_110 Permit Number: \(01C�
D "OCT 2X1016
•
- 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 '1S
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: nn '1�S
Legal Description: tJe' 4ei IS1j1,,_ .Pj CAyclo - S"ecfionil {%rZ-1 11 .ASI fwrafa c (c 'i COIMM.oiq
Property Tax ID#: !�Cl " 02103 _000-LI Lot No.
Site Plan Name: Block No.
Project Name: X11\4U\ -
Setbacks Front Pack: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�.�e exls tiff SWr,,j1C raj ko die l',Ic ,rw ,,l .�-to cads,ir�s�a lLQ QA5
kXA , 1 h S- a-OJU WAAJ AUV-,, S I t�YD cr-�' K�na� �a fr►i-e
312 Nwg 15-1123.�a Cqu,lf II \eS-1. 21212 SsAt�>�
CONSTRUCTION INFORMATION:
Additional work toe e orme un er t is ermit-c ec a appy:
HVAC []GasTank as Piping Shutters Windows/Doors
O _
E
Electric Plumbing Sprinklers Generator Il Roof
Total Sq. Ft of Construction0:—.a_00 S . Ft.of First Floor:
Cost of Construction:$ "� , I (x) Utilities:cnSewer Septic Building Height:
OWNER/LESSEE: " - CONTRACTOR:
Name 44 Name: I?P Olben)DELC6
Address 1-( NS � VU
Q � Company: �-&,eC o�l.A QeeA ?JCS,, l.,\iG
City:fix`SQ,I(1 '?,%Qdi State:C C, Address: 95'1S W R wu C 1 -41
Zip Code: �AQ S 1 Fax: City: Vero dP0.Ch State:_
Phone No. (yG- Zip Code:S2 G(0 7 Fax:
E-Mail: a'M� _%CL AP,z.Qit..i( M-} X' � Phone No. 112'31$ 'L)(o0y
Fill in fee simple Title Holder on next page(if different E-Mail: 101R P.PeC�Q 4 Y .CJGIA
from the Owner listed above) State or County License:SCC \3.3n G'P
in
of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: ;
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: f—L Name:
Address: 2"SD SW 13 e, Address:
City: QtIo 1k4PO-0n State: ) City: State:
Zip:3 1oq Phone: 7tpo n Lo$ 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 the permit 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 1 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 Commencement.
kA s
_Signature of Own / ssee Agentv o E Signature of Cont or/Lic nse Holder
Z a N 0 } 00
STATE OF FLORIDA I a STATE OF FLORIDA Z � N
COUNTY OF CASs 1— COUNTY OF U. LL
Vi oroa, �. N
The f rgoing instr ee t w.� ss acknowledged befor W `� z The for oing instrument�w,�as,�a-cknnowledged before me W o ro
this day of �L��N 20 10 thi day of QC 0UU 20 �P by ® vi
o d a � U
W a
(� n Ct y X O c a
2 W n �✓11 0 > X LL
(Name of person acknowledging) (Name of person ackno edging)
..� .. 44
.. :. n
(Signat re of ota Publ to Flo 'da) (Signkurd of Notary ate f Florida)
Personally Known ✓ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS