HomeMy WebLinkAboutBUILDING PERMIT APPLICATION•
ALL A LICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q-
Date: Permit Number:MEMO
Q "
i r SCANNED RECEIVED
BY
............._......UC/ 2 8, 2017
Building Permit Application`s. Q.ucee®t�
Planni g and Development Services Permitting Department
Buildit ig and Code Regulation Division St, Lucie County
2300 0rginia Avenue, Fort Pierce FL 34982
Phon( 72) 462-1553 Fax: (772) 462-1578 Commercial Residential
PER
�IT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPpSED
IMPP , U��1l NT L�i~A�ICi1 i a
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Prope Tax ID #: _ �UV�^ 006k —UOlL ��_00 `-'I Lot No.
I Site Pla Name: Block No.
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Projectlame:
Setbac s Front Back: Right Side: Left Side:
i
61"k
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Zn, !` J�l�' �dhcr�e �c�erlay►-r,cn1 )b(4 % _2Cd • Tn�4a11 I " ncu 1
roo l; `1r+� • FL I 0 22 5 . �LrS��I l t��i Gnd c i-,t s CAS pled
Aaaiti Arai worK to i3e errormea under tnis permit - cnecK aii apply:
VAC 0 Gas Tank E]Gas Piping _ Shutters Q Windows/Doors
�/
O Electric 0 Plumbing Sprinklers � Generator I� Roof 12. Roof pitch
i � Total S('. Ft of Construction: 4{ (��2. S . Ft. of First Floor: C4
I !
Cost of fonstruction: $ y°2,5 Utilities: _Sewer Septic Building Height: 0
Name i; 1-: Name: Y)'kLbC KKJS. �(n* 1.nA�C
Addres : ��� Company:1_eol�� t x,AS�M5 t`%xJ) Eqm-v
City: r 0 ezrcc State:FL. Address: .L0�0 Zip Co e: Fax: City: Q Q j EYYCC State:(.
Phone o._nQ-2)9 L- Zip Code: ,'-_�QQ9& Faxes
,�,• �1�� E-Mail (0:YM<'z' ®w-GA Cc("() l Phone No.
Fill in fie simple Title Holder on next page ( if different I E-Mail:6 J (�-c_or I
from t p Owner listed above) State or County License: k _
If value''if construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGI
Name:
Addre,i
City: _
Zip: _
FEE Sill
Name.
Addre�
City:
Zip:
INEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
State:
Phone:
PILE TITLE HOLDER: _ Not Applicable
Phone:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
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, n conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structur' . 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 accorance 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,
accessoiy 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
impro �ements 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
comm'!ncin work or recording our Notice of Commencement.
L//� ��C O�� V Cat& s
Sign tur 11 o Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE IPF
I STATE OF FLORI
COUNTY OF
wCa 2 COUNTY OF��, (�J
The
The forgoing instrut was acknowledged before me
� en
this day of 20 1&by
i r n ,
(Name Of person acknowledging)
(Signatd.re of Wotary Public- State of Florida )
Personaloentificat;p-
ly Known —lam OR Produced Identification
Type oflo 1 ^ i
%IP& SALLY PORTES
n No. mmissJ5ea$)GG 47625
y �.,= My Commission Expires
November 15, 2020
07/15/2014
The forgoing instrument was acknowledged before me
this _2L day of 20 JL- by
J Jr, >(A � inn I I�
(Name of person acknowledging)
�l rtr1✓l/�V�
(Signatur of Notary Public- State of Florida )
Personally Known _� OR Produced Identification
Type of Identification Produced
Commission No. C C 0" "F SA(a&"ORTES
=� Commission a GO 47625
My Commission Expires
"amna"IN OVem 15 er 0
REVIE
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FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
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COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
ITE
COMPL
INITIA