HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I h)� 0
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REF
Building Permit Application MAR 17 2017
Planning and Development Services PERFvJilTTlNG
Building and Code Regulation Division St. Lucie County, FL
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
PROPCI,SED111/iEM:ENT LOCATIfJN:
Address: 3 �/9S/
Legal Description: 1W eA d/oL✓o vd/tj✓!1 etre 67 J' ( , 17 AC) Or 7 6 -My;:
Property Tax ID#: 43.3 "50,3 - DD1/r 0003 Lot No.�_
Site Plan Name: Block No.
Project Name: Gc/o'llC
Setbacks Front Back: Right Side: Left Side:
WNW,.
DETAILED DESCRI`Pl"Id 01= WORK.
41 Ole- IAi, off' IV(
C®.NSTRUCTI®.N I;IF.HIMA1"I®N:
Additional work toe performed under this permit—check a appy:'
HVAC Ei Gas Tank Gas Piping M
Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
O�
Cost of Construction:$ .S7 c2 0 Utilities:0Sewer[]Septic Building Height: J
®WNER/LE�S�E�E; �. CON�TRACT'®.R: ,
Name Gi tr) &L.' < Name:�o�G. I (f'14'14) G
Address: Company: Co G,J1-.cl J'�orr"�2' Qadl� '�hc.
City:�'�;Grcc State: .9'(/ Address:X�6,2,76 L, &of-
ZipCode: .3e/`7S1 Fax: itv�A City: /`7`• State: he
Phone No. 72,2- S7_,2—,vlv2 Zip Code: 7!V'9 L14 Fax:7,72-91& A.W
E-Mail: �Al�id Phone No. 7 7.2-yy//-01116
Fill in fee simple Title Holder on next page(if different E-Mail: 7—o `». fkfJoTG Veli Wo.-Go•w+
from the Owner listed above) State or County License:,!�cG j,3 !!c r,9
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Sl1PPLEMENTAL C®NS1'R',11(:TIDIV HIEN IOW IN!FQRMATLON
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: 04 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 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.
_Signature of ner/Lessee/Agent Signature of Contractor/License Holder .
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFi=^t��e COUNTY OFw
Theforgoing instrument was acknowledged before me The forgoing instru ent was acknowledged.before me
this kO day of Mnu /l 20 11 by this %0 day of WICI kCl/iiii.- 20 V1 by
(Name of person acknowledging) (Name of person acknowledging)
L&alcul —QM, myr)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known r _ I n ic„tiPersonally Known OR r d ed Identific tion�~ '
Type of Identification P d G J 11 'Type of Identification Produce
YP MAW
°A�': RACHAEL ANN MESStr1E
-f _ Not blit-State of Florida �. s� ;°�
Commission No. li�r 0 �.. - e •_ ��a�� 'Commission No..-K v 1 "�. �, , .�5�81�ry Public-State of Flo �a
oc My omm.Expires Dec 18,2017 =,• + rc Mom
=q. y Comm.mo, x ire
F oe,`` �.` . P s Dec 18, 1
71
or Ft,,• Commission # FF 077987 Commissib
n FF ozzpg
Revised 07/15/2014
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