HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALLAPPUCABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE AOCEPTED ) ' / �}
Date: Permit Number. ' Yo 1 " �% `7� I
SCANNED RECEIVED
BY
at Lucie County JAN 31 1BIB
Building Permit Application permitting Department
Planning and DevelopmentS64ces st. Lucie county
Building and Code Regulation Division
23W ITrginta Avenue, Fort Pierce FL 34.W
Phone: (M) 4s215s3 Fa= (772) 462-2s78 'Commercial _ Residential
PERMIT APPLICATION FOR:
PROPOSED.IMPROVEMENT LOCATION:
Address:
Legal Description: -�
Property Tax 1D #: Lot No -
Site Plan. Name: c�agog [ [T Is G- f wrV y� Block No.
Project Name: , ' /
Setbacks Front__ Back N I Right de: N Left Side:
DETAILED DESCRIPTION OF WORK:
_trm q C4 rPcfi'f
a
CONSTRUCTION -INFORMATION:
rtiona wo to rme under is pennrt-� a • apply.
I]HVAC OGasTank DGas Pi01,ping Shutters �...1 Windows/Doors
Electric 0 Plumbing Sprinklers Generator 0 Roof
Total Sq. Ft of Construction: r 5So. Ft. of First Floor.
Cost of Construction: $ 010'1 C1 O-, Utilities: Sewer IjSeptic Building Height:
OWNER/LESSEE: CONTRACtOR:
l / _ /o A
Name i1 Name: ce-
Address: it I re. ecc Company: r
city:re. rc2 State: �L- Address: E
Zip Code: ,3 �`l S^/ Fax: '_�` City: F'f I� s��
ti Phone No. - 7 i a• " y�i � �' � � Zip code:.3 ��l � -Fax: % 7 �- ` �6 �tl'
E-Mail: - Phone No. 7 �-� •3 6
Fill in tee simple a Holder on next page ( if ditfWa t E-Mail: ce(2cur d
from the Owner listed above) State or Cou -tense:
If value of construction is $25o0 or more, a RECORDED Notice of Cominencement is required.
i
0
Name:
W.
zip:.
/6
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
.City:
Zip: Phone:
MORTGAGE COMPANY: ' Not Applicable
Name:
Address:
City' State:
zip: r Phone:
BONDING COMPANY: Not Applicable
Name.•
Address:
Zip:, Phone:
1 certify that no work or installation has commenced prior to the issuance of a permit
St Lude County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with aw�thnyy a�ppgcable Home Owners Assoaation rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult your Home Owners Assadation and reviec
w your deed for any restrictions whih may apply
in consideration of the granting of this requested permit, i do hereby.agree that I will, in all respec% perform the work
in accordance with the approved plans, the Florida Building Codes and St Lucie County Amendments.
The foilowing'building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screearoomVend accessory uses to another non-residential use
WARNING•TO OWNER: Your failure to Record a Notice of Commencement may result in yortir,9aying 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
Signature of Owner/ Agent/ Lessee tgrrature of Corrtractot"/13t�nse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Q+ Lugo COUNTY
The forgoing instru ent was a ftowledged before me The f I - da instrument was admowl before me
this -7day of 20 Airy this l .day o . 201 by
(Na o ackmowledging) (Name of person acknowledging)
(Si otary Public- State of orida) ature of Notary Public- of Florida)
Personalty Known R�rB'Llehed lddrdification=� Personally Known OR Produced Identification
„"1",,, LASHAHNA ING Type ofldentificationProdueed
Type of Identification P "`� - oulke 01 F1617n
""""�. LASHAj�D^1GRAM
• * My�m Expires Dec 20, 2018 tAmmiSSlon NO. So`°av n�°�'% J4WQ.
Commission No. =N _ otary Publi oi` �e of Ftorlda
P; a-5sion # FF 177249 ,
•''� �d'� Bonded IhrOuph National Nalary Assn. : _ +� 1Ny Comm. Expires Dec 20, 20i 8
.r ;y _ _
L-!J
Bonded through National Notary Assn.
Revised 07/15/2014 ''�'
REVIEWS -
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR.
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETE
INITIALS