HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �1 1�� Permit Number: \611
RECEI`.' :D NOV 18 2016
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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:
PROPOSED 1NP OU,aM�E� LI�G�ATI'O'N:
Address: t&9 (-t iL-Fosa 'lX2�rE Y � 2t r v Qt
Legal Description: �fi( �rw.s �f� L� i �. �!"•1- "� ip4 ZcS�
Property Tax ID#: /�f �_ �Dc� 019z 5� On-J Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETA L aD SSC r 10
''(-c� tP�-��v� s l�cJ.sf.��� /-27.55 �t�e.. ��rr�r►.►c� AN� ��st;� 'h.��;
c5G�WC�t�c�5 ASD `est c UL'cn � 6Z PrzCtk ,[I A'D..`_l 4v-
CONSTRaU Tt0 I�NiF®R :` TION
Additional work to be performed unclerifili permit-c ec all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 430LV� Utilities: —Sewer —Septic Building Height: t Q �
110AWIN,'ER 'I ESES E4 0W.TR CTOR
Name Lit tomNam"'.
Address I lJD Ikt�rac�f :. Company ;C s ,� c=«id u-c_
City: •fSu Stater Address: :,3Z'�`'[ t�i�113DG� �c1E
Zip Code: LN - Fax:' City: 'Fi- PCSt�L�` State: -1--t
-
Phone No. `7-rz- 332. 7D'(Ir - Zip Code:,3f(ci 82 Fax: -n-),i 6(-(a11k
E-Mail: Phone No `nZ 2116 —$D�D
Fill in fee simple Title Holder on next page(if different E-Mail (A-.S-rno"
from the Owner listed above) State or County License 4fe4Q / oaq
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPRL A CONST CTI �'
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Man ATT® .
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: 9_� Y_or�'_r 5 Name:
Address:-lads 'Et�LsC_ GAce, Address:
City: PS L_ State: City: State:
Zip: Phone Va(g '�r� Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFF.IDVIT: Application,is hereby.made to obtain a permit to do the work and installation as indicated.
I certify that no work or installatibn"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 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 ins do ou intend to obtain financing, consult with le or n attorney before
commencingw r or cordog your Notice of Commencement.
Signa tu o Owner/Lesse ontractor as Agent for Owner Signature of Contractor er
STATE OF FLORIna STATE OF FLORIQA
COUNTY OF . LN c, \--P' COUNTY OF s }-� L uc\-'k
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of i\)OJ , 20_% by this�day of d 20IG by
C- Q S V n r g 0 d.`Ir e J 'e Ck .A o r v
(Name of person acknowledging) (Name of person acknowledging
(Signature of Notary P lic-State of Florida) (Signature of Notaryublic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced L ANProduced'SAN \.
typMpR1E GNENS 23 OFJWN4 tE
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No�ry PubNc
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETA T SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 112014