HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED.
Date: I Permit Number:
Building Permit Application MAR 17 2017
Planning and Development Services PEP,MITTING
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 �C
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMI'RaVEMENT LOCATION
Address: 0(0 -fA,) 0 fir. Fo.-t 4,���e V'L
Legal Description: ''ndicn (kLue-r On IV 05 11 K 77 1-at (MSP 34 /I/N
_(OR 3(.a� - LoSo•. 3670 - 136b • 36.73 - pall
Property Tax ID#: 3 y 01 - t l o X15 - 000 - 1 Lot No. /o
Site Plan Name: Block No. 77
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETA LEDf DESCRIPTION OE 1lVQRK '
Re•��e Wid Qep(Sc.e Sirdlis CI;z -ho Dooc k
CONSTRUCTIOIU INFORMRTION T x
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ItIonal work tor orme under this permit c ec a appy:
HVAC 11 Gas Tank Das Piping Shutters Windows/Doors
OElectric ElPlumbing OSprinklers OGenerator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ /b 0,9_00 Utilities:Sewer 0Septic Building Height:
OIIUNERjlESSE CONTRACTOR ,
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Name_ 4-Lw J!:e'%cP ,..ci�i'rh Name: 61,1wc.te-)o Cortft.
Address: 560 IV& t ice Park Cr_ Company: Conti COn-ir-C, 1-,-IS
City: 'Por-}- 1-kc-le State: rL Address: 1q79 3C Cc,.-, ,l", S-1.
Zip Code: 3y V3 Fax: . City: (4- L"(-fe State: GG
Phone No. Zip Code: 3 SSS Z Fax:
E-Mail: Phone No. 77d- - SO-2 — ok cell I
Fill in fee simple Title Holder on next page(if different E-Mail: -0c Co. *-C'Cjn1 ark?r� �^-►�<<- �o^,
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from the Owner listed above) State or County License: G(3 C 1'95es-o5
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPp�CEMENTA Cai STRUCTI£7N LIEN LAIi IN ORMATION•�
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: N A Name: Nor
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name: I"A
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.
5
Signature of Owner/Lessee/Contractor as Agent for Owner SignaiuW of Contractor/License Holder
STATE OF FLORIDASTATE OF FLO A
COUNTY OF S� _ �� _ ICOUNTY OF
The for oing instrum nt was a nowledged before me The forgoing instrument w s acknowledged before me
this 1 day of20 by this day of 20 by
�r�nccr>r �n�
4)Qdn r 16
(Name of person acknowledging) (Name of person acknowledging
(Signature of Notary Pu k_State of Florida) (Signature of Notary Public-State of Florida ) /
Personally Known OR Produced Identification Personally Known OR Produced Identification v
Type of Identification Produced Type of Identification Produced L V)•�
� � ¢ NP.NCY J.SHEA
Commission No. .`tra`"oe� (Sea[ mmission No. ,, ,,
�`� Noefar}�Public-State of Florida REN S. NIELSEN
•_ My Comm.Expires Oct 19,20 7 =� - Commission S FF 11563
.0 t_
n x = = M Commis ion i
June 12, 2018
hmn� 0onded Through National Notary Assn.
Revised 07/15/2014 y -,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS