HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: mber: hz,(6-
MTJ "M37"TAT—T-l"071 BY
Lucie County
Buildi JUN 2 6
Planning and Development Services '�nWrllrnit Application —2015
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROVEMENT LOCATION:
�J in d1i
Property Tax ID it: /�/
17-13a-060c2-40V-3 Lot No.
Site Plan Name: /�;2411V7W-7111.5 /OA-65 Block No.
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side:
60�0C,^If7��— C0111'61ee7e,
Left Side: Az-f--Y5
000 Asr (f0,VCfReJ0_ 6Z
I CONSTRUCTION INFORMATION: III
HVAC
E] Gas Tank
. Gas Piping
U Shut'ters
Windows/Doors
Electric
1:1
Plumbing
OSprinklers
1:1 Generator
E] Roof
Total Sq. Ft of Construction:
5�8_ Ft of First Floor:
Utilities-t) Sewer OSeptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
I
Name— 2-�- AZ-C--
Name:_1W61V
81�ell
Address: Z49,:2_7&2 �SZe7rygWC
Company: 41c�<
City: S_Iadz� State: a7-
ZipCode: �R!�09a Fax: 7446,5_
PhoneNo. 90/---3a3-9w/9
Address: /,5-e 7
city: _T�4 �2jrzE_xo_
ZIpCode: ?,_'3z176
Phone No. :242
Fax:
State:-Ag,
—
E-Mail:- LA�?M4 1nr6__C'o lnitl�e_ , L621V
Fill in fee simple ritle Holder on next page ( if different
from the Owner listed above)
E-Mail:
State or County License: Cr7 ne')
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW �IN FORMATION:
DESIGN ER/ENGINEER: —
Name:
Not Applicable
ZAwdSz4PL8,,a.4
MORTGAGE COMPANY:
Name:
11�Not Applicable
Address: Z-71 12D.,
A/.
Address:
City:
Zip: Phone: -5-61-3
State: F4-,
?6 - /
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _I:f
Name:
Not Applicable
BONDING COMPANY:
Name:
V�Not Applicable
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.LucieCoun makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conlylict 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 lender or an attorney before
W. WA 4 M''
- Sigfiatur(yf Owner/ L,
0 � W'', I i M
STATE OF FLORIDA STATE OF FLORIDA Zle
COUNTYCIF _evy) COUNTYCIF
The'fWooffig instru!nImt yjas acknowledged before me
th —Wayof /Ij(01/ 20/,�_by
1. A
rf person
(Signature of Notary Pub9t-State of Florida )
Personally Known VZ OR Produced Identification
Type of Identification Produced
Commission No. eF- 1 -79 N91CA FEEHAN
NOTARY PUBLIC
Revised 07/15/2014 %T. Comm#EE179392
to
E)mIres 612412016
The forgoing instrument was acknowledged before me
this,?Pl'd)ayof t—/azj 20 L�L by
aill L 0_X2_rr1,r0-)
(Name of peirson acknowledging)
r r
(Signature of Notary Publ' ' State of Florida
F_
Personally Known Vl� OR Produced Identification
Type of Identification Produced
Commission No.eF-/ 7?37,2 JESSICA
At'Re'NOTARY
Comm# EE1
Expires 6/2
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TU RTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
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