HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR.APPLICATION TO BE ACCEPTED
Date: %'i, /J^• SCANNED Permit Number: SO9^d I
BY
St. Lucie County RECEIVED
Building Permit Application SEP �4 2015
Planning and Development Services
.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: c4eot(n� III
To Select from dropbox, click arrow at the end of line
I.PROPOSED IMPROVEMENT LOCATION: III
Address: -.;? 00 611-6-4AJ31 cFY 49, , !3i 10169ee-c /� 3 Vg9iZ
Legal Description: 3, 4 36 y0 Them IWI-i9r- r�% ✓Jt� f1✓/l i SAS% /�iin/G �rOO
Property Tax ID #: �'/01 -_33 - 0002 Lot No.
Site Plan Nam(
Project Name:
Setbacks Front Back:
Right Side: Left Side:
I DETAILED DESCRIPTION OF WORK: I
�,✓s)�U_ /2X,Z/ C/fRDLir✓xj
CONSTRUCTION INFORMATION:
HVAC LJ Gas Tank
Piping LJShutters
❑Electric ❑Plumbing []Sprinklers ❑Generator
Total Sq. Ft of Construction: 7-92 3 S Ft. of First Floor:
Cost of Construction: $� rDS • t _ _Utilities: Sewer-[] . Septic__
- - -- - - ro�-FS9 —.
❑ Windows/Doors
❑ Roof
Building -Height:
OWNER/LESSEE:
-CONTRACTOR:-
aN me %rir C is / Nr7cJcvl � r/wn
Name: �o�� T•OlUr )
4ddress:^7` -ZO3 Zr,Z r 0 2e) e
ompany: -Qrc% vjA R'-n %tr,
s Ll c
City: P L-_-Ae Le 1-"L— State: _
Zip Code: Fax:
Phone No. % %Z- ylio S SCSI
Address: I}oy, 2151,5241
_U
City: 1564eru_
Zip Code: 3I�A1c� Fax:
Phone No. - 5 -1 If 4
State: -EL -
17a-W-Cogs ' °+•
E-Mail: j�W 0 17hrcfl,LeS� C#tevfo#, Gil
Fill in fee simpie� r on next page (if different
from the Owner listed above)
E-Mail: Joel (� Atta Aq�� So
w s .GOM
State or County License: l-6c 1-.)A
�,3103
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
2 52 s
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERf ENGINEER:
Name: e6c'Z4f _JL_ Ai A
— NotApplicable
? -t—1 5e
MORTGAGE COMPANY: _ Not Applicable
Name:
AddresS.'9605 'dJx
Address:
City: . " L t
Zip: Z Phone:
State: L
e-
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
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 lender or an attorney before
commencine work or recordine vour Notice of Commencement.
_ Signature of Owner/ Less e/Agent -
STATE OF FLO IDA
COUNTY OF \.i,� Lou,
The ing instrRment was acknowledged before me
rgo
this day of J pQ}Prn 6!< 20 4Eby
(Name of person acknowledging )
'(Signature of Notary P.ublik.State of -Florida-) - — -
Personally Known.. OR Produced_ Identification--
Type_of-Identification-Produced- --
PC O A JACLYN OAWSON-0RE
Commission No. lJ��' .�NrARYPU®LIC
a .._ �.g0, {STATE OF FLORIDA
Revised 07/15/2014 ft�FIql- Expires 2/4/2017
C.c UZ S
Sig a re of Contra or/License Holder
STATE OF FLORIDA
�?� �n
COUNTY OF 'X jy, bifJW
The forgoinginstr mentwas acknowledged before me
this 7 day of 3e0-t! m be, 20 /S by
sow 2Qk�
(Name of person ack owledging )
NotaryPublic-State of Florida-) — -
)wn�� — OR -Produced -Identification— _
No. "" ' C?/ 1 J DAWS
Y PUBLIC�RIc
�NKsB, STATE OF FLORIDA
Expires 2/4/2017
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS