HomeMy WebLinkAboutBuilding Permit Application 04-05-'17 09:01 FROM- T-702 P0003/0003 F-976
ALL APPLICABLE INFO MUST BE COMPLETED FOR•APPLICATION TO BE ACCEPTED, `
Date: `t� \� Permit Number: !� 1
RECEP.—D APR 0 5 207
Building Permit Application
Planning and Developmerit Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 '
Phone:•(772)462-1553 Fax:(rig)462-157$ , Commercial Residential
,PERMIT,APPL,ICATION,FOR: To Select from dropbox, click.arrow at the end of linev�e
Address:• i5 to ,a.. ja4X3 . ' » -
Legal Description: 1,, A' 'R&ti'Ts a - V'4A --_Coote RA`C ilia U Ji d .,,,,.,,...•,,,,,,,,,,,,,,,•..,_�...._
73-eq-7 942
Property Tax ID#:' 3 tl �' '�(� .' O oR 8 066-O Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:."
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101 a NMI
a. rKtobaparformed under this permit—check a apply.,
AC IE]Gas Tank ❑Gas Piping _Shutters E]Windows/Doors
Electric 0 Plumbing'' ' Sprinklers• Generator Roof . Roof pitch
Total Sq.Ft of Construction: SIC Ft.of First Floor:
Cost of Construction:$ 4 o Utllitiit. Sewer El Septic . Building Height: ' '
Name 5C� 3 .... i n,7 Name: '-Z�f4E �'L e�d�►
Address:"?(,Lt 1 MA&4 Amos Company: a e*v- A'i4--• 1-0-C H,AM Log P_S
City., Rda: .4� 1,VC_I& State: Al- Address: 1572%NTa-)'f,LJF_X Clkct',
Tip Code:3 Y9sa Fax: city: ba;r"W Lvcr& Stater,
Phone No. 772- -7 Qq 1 Zip Code: 3i1R�� Fax: -_3J=- ?f? +r
E-Mail: Phone No.77 n� 23.V' oto et
Fill in fee simple Title.Holder on next page-(if different E-Mail,.•VA.Ar /5 $ ,qet: Co r-n
from the owner listed above) State or County License: CAG o :5266a
R value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
04-05–'. 17 09:01 FROM– T-702 P0002/0003 F-976
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DESIGNS ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name;
Address: Address:
City: State., City: _State.-
Zip: Phone: Zip: Phone:
FEE SIMPLETITLEHOLDER: _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 theermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or andcovenantsthat 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
commencin work or recording your Notice of Commencement.
s
Tafffe of Owner/Lessee/Contractor as Agent for Owner SI LAW Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF 5-1 L,,Xcls GgtN J COUNTY 1. ui
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this S' day of rA 14 0M L— : 201Zby this 5 day ofA o t. 20 ,7-1 by
-cre IF F AtmgA �^r�EF ALmeir
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida} (Signature of Notary Public-State of Florida)
Personally Known___ZOR Produced Identification Personally Knowe_OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Commission No.
SANDRA Vi/AL$i l Mile € SAN13RA WAH
LS
MY "Min POP——
Revised 07/15 1 ` X EXPMES April 11,201 a �, �� EXplFlES April
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS