HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a al Permit NumberA 5 6 DL-OZIG
ooLterNcc 1!:c),-oho
•RECEIVED Building Permit Application M 2
planning and Development.Services SCANNED �1�
Duildfng and Code Regulation Division BY
2300VlrglnloAvenue, Fort Pierce FL349a2 M. Lucie Countv
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of Ilne Ill
Legal
Property TaxIDtt �Yo23 -� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front_ Back: Right Sider Left Side:
s�-a1 / Cv»•t rrce_r¢t�P C�r�,tc_te
IJHVAC U Gas Tank ❑Gas Piping
11 Electric Q Plumbing OSprinklers
Total Sq. Ft of Construction;
Cost of Construction: $ 00 O� ,
/C
Shutters n❑ Windows/Doors
Generator L Roof
Sic Ft.( of First Floor.
Utilities L_J Sewer []Septic Building Height:
OV1li11ER�ESs�6°?..r...
is
Name Iwroovr FIvl•TS , 1.LG
Name: b
Address: Z1-I (4VA%Qitnawnn WA../ ttrJ 6,
Company: R e G t,UYIC►� OD , C
City: A%IPAState: �l,
Address:'& Gr 2
Zip Code: SZ 4 4y Fax:
City: Stater
PhoneNa. 561•133-MOO
Zip Code:,3"So2 Fax:47a•'fG7 /Ioa`f
E-Mail: kec @ Ccm
Phone No. 9- 878-775a-
FBI In fee simple Title Holder on next page (if different
E-Mall: rqe vLa., &Z_ cwa'�A loco Is - 0-0-tZ
State or County License: CPC /5�J'
from the owner listed above)
IIIf value of construction is $2500 or more, a RECORDED Notice of Commencement IS required. II
U,P,LEMEN
LC NSTRU
DESIGNE ENG�
Name:
R:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Addre s:
Address:
City:
Zip:
h e:
State:_
rl
City:
Zip: Phone:
State:,
FEE SIMPLE f LE HOLIER:
Name: _
rbt Ap le
✓r
BONDING COMPANY:
Name:
Address:
_Not Applicable
Addres
City:
r
City:
Zip,
Phone:
fat
Zip: Phone:
I certify that no work or Installation has commenced prior to the Issuance of a permit
5t. Lurie County makes no representation that Is eranttng a pennitwlll authorize the permit holder to build
structure. Please consultwltti your Home Owners Association and review your dead for any restrictions wnlcn may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, Ina[] respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St Lurie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-resldandal use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result In your paying twice for
Improvements to your property. A Notice of Commencement must be recorded and posted on the Jobsite
before the first inspection, If you Intend to obtain financing, consult with lender or an attorney before
Slgnature fb Agent/ Lessee
STATE OF FLORIDA a I OUNTYOSTATE OFFF ORiDAS+.
COUNTY OF at m PJtin°h
The forgoing Instrument was acknowledged before me The forcing In nt was acknowledged before me
this 9 dayof tT ar 204hy this J.dayof crc 49'7AI"%-W
^%II— ►Lri&viy6L, mar$incttt
(Name (Name fperson acknowledg )
KRISTMMAR5HALL
caRnusslat # EE 138079 1
Expires FebnialyB, 201g
(Signet { gnature of Notary Publlc- State
Personally Known OR Produced Identification _ Personally Known �_ OR Produced
Type of Identification Produced Type of Identification Produced
Commission No. (Seal)
EXPIRES October 28, 2018
Revised 07/15/2014
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETE
IS
INITIALS
SUPPLEMENTALCONSTRUCTION LIEN'LAW INFORMATION:•.'
DESIGNER/ENGI EER: Not Applicable
Name: '3 :Sing
I nC�(2Y -
MORTGAGE COMPANY: _ Not Applicable
Name:
Addr
r
Address:
City: State:
Zip: Phone; -
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 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 I�rider or an attorney before
commencine work or recordine vour Notice of Commencement. /
_ Signature of Owner/ LesseefVAZgent
STATE OF FLORI l COUNTY OF l
The �?(�ipg In str nt w s acknowledg efore me
this May o 20�by
(SigKaturdbT NotaryPublic-Staatye ff a)
Personally V R�M'Gdentification
Type of Id EE1L
Commissi 1Dj201ea1)
Revised 07/15/2014
STATE OF FLORIDA
COUNTY OF I I�YIJ
The 'fo4 ing in str enOwa acknowledg d before me
thisG day 206by
(SigVatu?of Nary Public-S to of Florida )
Personally Known RTIMMAWMIlon
Type of Identificat d10TARYPUBLIC
STATE OF FLORIDA
Commission No. EE1440M)
Expires 8110/2015
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS