HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETI )R APPLICATION TO BE ACCEPTED
Date: \� 4 CJ Permit Number: 1 5 \O 0317
RECEI`.'7D OCT 2 0 2015 SCANNED
BY
%� St. Lucie Countv
-- _ -- --- _ Building Permit Application
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: CClrn _ QUt� A
Address:
Legal Description:
Property Tax ID#: `4119 - \\\-C>60 \ - 00C) I% Lot No.
Site Plan Name: Al I,-,. a1 CD S L S TC/'% Block No.
Project Name: V'o Suf s er
Setbacks Front Back: Right Side: Left Side:
_Mechanical
_ Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
�1 (/ J
Cost of Construction: $ 904000
Gas Piping
Sprinklers
_ Shutters
_ Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof
Utilities: _Sewer _Septic Building Height:
�OVI/NER�/L SSEE:
.CONTRACTOR:
Name
Address:Q()1 A)9nI )
VC
Company: �o2 .\1�,y►S
���
J;V(
City: Y�'\� O' M � State: PL
Zip Code: S \1 Fax:
Phone No. 6 4 , 6 19
Address: -70 1 Vk0.r)-,4Cke%
6Z_ 0
City: _V:� nrirLp
Zip Code: *A�MLii-1
Phone No 4 4 /-
Stater
Fax: Y6 ( c(7 -2 1
E-Mail: Ron Z p A\\ i,.e Ck 0nv-(`Sq\ .Ca
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 07" : -Y c;A dyA
w"t\•ux5 (b4 L Contras)
State or County License C'_GC-
150 q �8
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONS RJCTION
LIEN LAW IN
ORM-TIO .
DESIGNER/ENGINEER:'
Name: ('st VJ rlenar
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: q.
VA
Address:
City:Li� V qItr4C
Zip: "z14ga-, Phone t4/e0.n-,r_t
State: L
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPA Y: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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
commencing work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/Agent
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF Cam.
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of a\� 20_\S� by
this daily of �20_Wby
7N-\—Kr nrr_ % l�\�f�
A��I6 0,C, W�.L`C_fYS
(Name if'person acknowledging)
(Nameofperson acknowledging)
(Signature ota P,ubll''' State of Florida)
(Sign ure of otary, Public- State of Florida )
bl
Personally Known v OR Produced Identification
Personally Known `� OR Produced Identification
Type of Identi
Type of Identification
Produced n.E•.. J.LBRIDGES
Produced J L BR1Sol)
CanrnssianirfE93472
- Expires September 13, 2016
Commission... '""> ....;Y-• ThwTmyFanLec � '0t9
,$;:hva
:,; r Commission # EE 834731
Commission No. :=r. y 70s
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REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
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DATE
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COMPLETED
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