HomeMy WebLinkAboutBuilding Permit Application ALLAPPLICABLE INFO MUST BE COMPLETED FOP,APPLICATION TO 1 EACCE.
date: Permit Number: kit
-,j;:'iL
R E C E I V D APR ? 7 2017
Building Permit Application
Planning and Devellopm, ent Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierre FL 34982 /
Phone:(772)462-1553 Fax:(772).462-1573. Commeri:W Residential
I I
PERMIT APPLICATION T®Sedectfro m- dropbox, dick grow at the end of dude S^
PROPOSED 1 P4bVEMENT CATiC N. -
Address: Z_.
Legal Description: jAjj (A6y plij EX C�
I I
'Property Tax ifs 4: 3 '4b ®`9 - a oo - f � Lot No.22 23
Site Plan Name: Block No. -�
Project`Name: ZkWli2•
Setbaclks Front &.O' Back: 10 6 Right Sidi: Left Sire:
i
AILED DE DET SCR1FTl+0N 4E'WORK .. .. _
ECONSTRUCT[gN NF0RMAT 0'
1
a itiona vor toe a orme under t is permit-ere a app
Gas Piping Lndowsj000rsJHVAC iGas Tanc -
l Etertric Plu:rhing Sprinklers F�Generator, ROof Roof pitch
,,y -
Tota#:Sq.i t.of Consrructi ����1f'` Sq.Ft.of Fm Fl
r�
Cost.of Construction..? 000 Utilities:USewer"septic Building Height:
0WNER/1ESSEE co
ETRACT0'k;
Name&AEK ---r I Dib N4 L• L.,ewis €lame: e#,f94t5_ X. 57e_A Q6�'I z
.Address: 62u AgEDIZ tae4 J,Campany. �d1!7: !M)C-riO 14&-_
City: UV4/iU 0S' State:/� Address: 2T
Zip Codes &7 3� Fax: !. City:' ��Q'16T - State.,AZ-
Phone No. �[' �`d�',3 ?1S ZipCode: -� _ Fax 29-7
E-lViail: 'Phone No., �?I - p% ,'�! �Oqq_j
F€lI in fee simple n site Holder on nert gage If different E-Pv1ai!: n C_A�re a e 4'P x ot_ . eb44
frorn the.0vrner.€isted. above), State.or County�'ceruse:, �� /45' 7 O 8N-
I
If valve of construction is$2500 or more,a RECORDED notice of Commencement is required.
� I
I
SUPPLEMENTAL:CONSTRUCTION:LIEN LAW INFQ RMATIOIV:
DESIGNERANGINEER: _Not Applicable MORTGAGE COMPANY: j Not Applicable
Name: F,4 it14:,, ,Name
:
Address: lf8* 5S ST _s7E l/+�' 'Address:
City: /-', L State: t=t_ City: State:
Phone:.77 Z.78 S- 4f399 'Zip: Phone:
FEE SIMPLE TITLE FOLDER: Not Applicable BONDING COMPANY: of Applicable
Name: 3�1�1r1>r his d1JilkeIr me:
Address: 'Address:
City: City:
Zip: Phone: Zip: Phone:
I
I certify that no work or installation has commenced prior to the issuance of a.permit.
St.Lucie County,makes,no.representation that isgrantingapermitwiilrauthorizetlie ermitholdertabuild'thesublectstructure
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 restriction's which may apply-
:In consideration ofthe grantirig of this reguested,perrni#,'i do<hereby agree'that]will,.inl all respects;perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The.following.;building permit:application&are.exempt;from undergoing..a-_full concurrency review:;roorrradditions;.,
accessory structures,swimming pools,fences,walls,signs,screen rooms and'accessory ses to another non-residential use
WARNING TOOWNER:Stour1ailure to Record_a'I�ilotice oKommencement,may result in your paying tii dce for
improvements to your property.A Notice,of Corntnencement rnust'be recorded and posted on thejobsite
before the first.inspection. If you intend to obtain financing,consult With Mender or an'attorney'before
Commenci, Work;or recordl our."Notice afCommencement_
J
s
-- Signature of Owner/ essee/Contractor as Agent,466r Owner Signature of Contr ctor/License Holder-'.
STATE_OF FLORID `I � STATE OF FLORIDA �
COUNTY OF VkA�T�� COUNTY OF YM G.(-in
Thq LQrgoing instrument was acknowledged before me The for oing'instrument was acknowledged before me
thi day of1S��� ( 2(hliiy this day of r 1 1 ,.CEP Iy
A. S
(Name ofpersonacknowledging-). T.-(Name ofi p rson:acknowle ing:).
I
I
(Signs#ure of Notar. ' u `lic-;S1 ate:.of.'Florida) (5ig re of"Notary'Ftiti is-State of F)orida.)
Type ldentifica n;PPersonally Known Srod d ro d Identlfi�ation Personally BARBRAA GOODMM Type of l"d'entif Known'o Pr d ORd," ;na jde 0ficatio =
(�IRES:March 12,2018 ,.�o�F �e'� SUE L.M
Commission.111o. O _�Qoo��dd Cvmrriissiora:N .. P (mil)
den t i RudgetNAiry Services e . c ➢ ublic-State of Florida
i�r My Comm.Expires Apr 9.2018
OFFOP•••' ion#FF 105468
h g National Not
Revised 07fT'Sf20'14 Bonded Throu Notary Assn.
i
'REVIEWS 'FRONT ZONING SUPERVISOR`: PLANS VEGE�IAT.10'RI 'SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE '
INITIALS
i
I