HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE -COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: PermitNumber:
RECEIVED JUL 09"2015
SCANNED
Building Permit Application BY
Planning and Development Services St. Lucie County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial 1'1� Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of lineC3'c�'-� a
rN., A. � I
Legal Description: 42A? V1 Ve e, Jelm )� Y1 Pe , g: .,
1K 5 S�Mjn Lpsec le6� s ZZ,5�,e 700
PropertyTaxID#: Lot No.
Site Plan Name
Project Name:
Setbacks Front Back: _ Right Side: Left Side:
.1e,Yel A4 e-,e 168 dkdee?,&� 2Q�A;q / 5d z*-J
AaamonaiWOMIQUe erTurmea unaerinispermiL—crieCKaii appry:
'r
la(3,as Pir Shutters
[:IHVA( 9G'asTank In OWindows/*Doors
45)1) );Yel
Plu It Roof
[]Electric — rn-bing [:]Sprinklers Generator
Total Sq. Ft of Construction:____ Sq. Ft. of First Floor:
Cost of Construction: Utilities: [:]SewerE]Septic Building Height:
64d
S E,
i'i� L i�
N a m e ow 660�.' S 0, e
Name:
Address: 11VAede I ��v-e 41-362
company: r&-Mhe"g"'
city: 0044�'?."
Zip Code: 33 / 3 Fax:
Phone
State./��
Address: ..0 -7,9- QW L);yl"' jj�14
city: 'SrZ4enfl-
Zip Code: 25#4947
Phone No.722�279�Z-030
State*'I�L.
Fax: 7,�V',?,ff7-3LXZP
Fill in fee simpleTitle Holder on next page (if different
from the Owner listed above)
E-Maikhok.'O'Sra�
50ZOW1
State or County License:
04-?32 4d/7
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
VESIUNER/EINGINEER: -,,,—^ot Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: -v� Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: ,,ITot Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: t*�`Not Applicable
Name:
Address:
Zip: Phone:
I certify that no work or installation has commenced priorto 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 lender or an attorney before
- Signature of Owner/ Lessee/Agent
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of 20 --by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of identification Produced_
Commission No. (Seal)
Revised 07/15/2014
OF FLORIDAW
FY OF
The for&p1ng instruTent was acknowledged before me
this 6dayof OLA, 20 16- by
J6 il C, 7%,e ol 6. /7�tr-O/
(Name of person acknowledging)
(Signbfure ofT4otary Public- State ofUiSricla
Personally Known ll.--�011 Produced Identification
Type of Identification Produced
Commission No.
17"11
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
M
DESIGNER/ENGINEER: _,,el\lot Applicable MORTGAGE COMPANY: _,,<ot Applicable
Name: Name:
Ad d ress: Address:
City: State: City: State:
Zip: Phone: Zip: _ Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: —
Not Applicable
BONDING COMPANY: 'INot Applicable
Name:
Address:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Coun makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in co 17tict with any applicable Home Owners AssoPation 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
commencing work or recordiniz vour Notice of CommencemeAt.
'E OF FLORIDA
NTY OF
The :fffing inst um t Was acknowledged before me
this day of 1,C (&4 20 -ay
r
JDA6PAa-47 C-�- MAA-�
(Name of person acknowledging)--,
(SiAhaturMf Notary Public- St
or
Personally �nown L--�CR
Type of Identification Produce(
Commission No.
Revised 07/15/2014
Identification
MY COMMISSION# EEI
*E OF FLORID'.1,,-b
NITY OF
The fo Ing Instrurpent was acknowledged before me
this 9dayof JL4_tq 20 16- by
6. ",(.;& I
-)rAc P, - rd
(Name of person acknowledging
(Sign6fure of T4otary Public- State oVrida
Personally Known L_�011 Produced Identification
Type of Identification Produced
No.
MY COMMISSION# EE116915
M.N.[�- �
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS