HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: IN16 ermit Number:
RECEI"-D ►��� 101
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 _ 0
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line ,fZe_,r0QY
-PROPOSED IMPROVEMENT LOCATION:
Address: )04 1�10JO skyC Qf. fz,(* RACY&— Com..34114,c-
Legal Description:-5reM;y1 f1azo,-Vri0V a '(Cy(0 s L0--61 4M
Property Tax ID#: M9-$o5--®061-Dor)-6 Lot No.
Site Plan Name: AJ/A Block No.
Project Name: 0M
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: 41la
V<y o vt- e1A,5+kw) s1 %VL5le. fouAY� stdVA-o� 4� (YLS&c�11 o, GidL>r uaw..\
5t1,y15l,r_ Yoc1FiW) SySAf^ ovt-- 3ei lir,
CONSTRUCTION INFORMATION:
Additional work to be nertormed un er ns
rmit-check a appy:
❑HVAC Gas Tank Piping _Shutters E]Windows/Doors
Electric Plumbing Sprinklers 1:1 Generator F]Roof 1 Roof pitch
Total Sq.Ft of Construction: N00 SFt.of First Floor: 1343.
Cost of Construction:$ 61600 Utilities:CnSewer OSeptic Building Height: 10"
OWNERAESSEE: CONTRACTOR:
Name i- cy M 5wirkk if fc%ft r, V-cz/.'L_ Name: 14cof.Lo LeLCZ^
Address: 104 Q?xzA Sti,-r'e- Df. Company: G- j'3rr_ Zw,1) tv j 5;olg hoytl �-Ie
city:_ fba- s{- wu4 State: PL Address: 413 5' L.ivncoly FIS.
Zip Code: Fax: City: s1-LJ4,/k-- State: {2
Phone No. Zip Code: 3493 Q Fax: ��-z-28Y 028
E-Mail:• Phone No. 643--W63
Fill in fee simple Title Holder on next page(if different E-Mail: add• C.'-'
from the Owner listed above) State or County License: Ccc t 3 3 C);'7+
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 recording our Notice of Commencement.
s
gnature of Ow sse X actor as Agent for Owner tgnature of Co icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF IcAMYl• COUNTY OF ft{ A
The forgoing instrument was acknowledged g�fore me The forgoing instrument was acknowledged before me
this I day of Rjd�PXhbG'( 20 bby this_!I_day of NfXl2 ioeir 120 16 by
19rc+c,mfrs LA(1� C\CQ,C&Q LaITA
(Name of per n acknowledging) (Name of pers acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
PersonallyKnown OR Produced Identification Personally Known OR Produced Identification
Y
Type of Identificatio Produced Type of Identificatio Produced
Commission No. (Seal) Commission No. (Seal)
W ••ti�PY,Pf➢S THERESA DE RITA
i yA
TS EXPIRES:October 29,2017 '*;' := MY COMMISSION#x FF 062929
Revised 07/15/2014 ?c Bonded Thm Notzry Public Undeniriters :o
EXPIRES:October29,2017
�!' OP•.
Elli6.g,9 .-..---' , %„4„,•• Bonded ThN Notz
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS