HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLE i eu FOR APPLICATION TO BE ACCEPTED
RECEIVED OCT 13 2015 Permit Number: _vs \O-dlga
SCANNEDBuildin 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 �_ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �\AYv` ,p III
PROPOSED IMPROVEMENT LOCATION: II
Address: 92,0 /9"/1J6a G e !J
Legal Description:
Property Tax ID#: /_7C9T7"'y/7 `UouZ -O
Site Plan Name: �&PT(TCIJ /Pbt457Y2/PS
Project Name: 77`"f fz✓QM
A�
Setbacks Front Back: Right Side:
Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
/JJS7`4I;L JAi9.006 ) CAp Rr9M P `r` 'P19 ILS to EVSTiuC /,411?9IIJ-6
CONSTRUCTION INFORMATION: III
aamonaiworKcoDe errormea
❑HVAC Gas Tank
unaermisperma—cnecKau
❑Gas Piping
appry:
❑Windows/Doors
_Shutters
Electric
0
Plumbing
[]Sprinklers
❑ Generator
❑
Roof
Total Sq. Ft of Construction: 5 Ft. of First Floor: A
p6
Cost of Construction: $ Z�OD o Utilities: Sewer ❑Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name l4to %
Name: oRGCic�e 26 � 20lC
Address: / AJ 64t? 0>
Company: 0,2f?L//ar_ A De2areav > eevae
City: A&RCP State: 9
Zip Code: 3 V9 09 Fax: '
Phone No.72_— g ri0
_
Address: a3o/ S JPb/&P-- Ie1LJ e42 7 2
City: %rr hefie e Stater
Zip Code/*w YZ Fax:
Phone No. JAG/ - 5-7 y-Q8/8
-772,—
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: P2!V &AW11"f 149DP)e_ft aH 12 , N e7—
State or County License:
i,C oe5
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
CONSTRUCTIOhi N'LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: i? Ida4eL _) TT/gu]
Address:
City: R AC e State: L
Zip: 33,J !y Phone: _ 92 3 3
FEE SIMPLE TITLE HOLDER- _ Not Applicable
Name: N ZQ
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
City:
Zip: Phone:
State:
BONDING COMPANY: /
Name: /
Not Applicable
Address:
City:
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 ecorded and posted on the jobsite
before the first inspection. If you intend to obtain financing onsuIt wi h lender or an attorney before
commencine work or recordine vour Notice of Commence ent.
/"/e
nature of Owner/ Lessee/Agent
STATE OF \
COUNTY OFOR A
The fo[ ng in e t w� acknowledged efore me
this`vn7—, y o � eJ�20�by
(Name of person acknowledging)
—7. L
(Si re of Pu_b1ic-_R5T`e5f Fa )
Personally Known OR Pr5Mb�ll JAgM ,cation
Type of ldentificatiori o olYCOynginuaEEIBM1
' * EXPIRES: January 22,, 2016
Commission No. 4Cocrr°P and ft BWA r
Revised 07/15/2014
STATE OF FLO e
COUNTY OF
The for, ins i en was cknowledged ore me
thisL day of by
(Name of person
Personally Known ✓ OR Produced Identification
Type of Identification Produced
Commission
EXPIRES:
A YASM
ION l EE 1SWal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
j
COMPLETE
INITIALS
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