HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I Ql\ 1 1. j5 Permit Number: s I a
RECEIVED DEC 0 7 2015
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 X Residential
SCANNED
St LucBY
a Counfil
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line 5 _ W,411
PROPOSED IMPROVEMENT LOCATION:
Address: (o - vil ' . u5 w 3
Legal Description: PVQ510 Se o_ " PrIh me_rl-F
PropertyTax ID #: l S' I i�o SOS- CC�� Lot No.
Site Plan Name: Block No.
Project Name'
Setbacks Front Back: Right Side: LeftSide:
DETAILED DESCRIPTION OF WORK:
Channe 1 Le1O2rir)1 — tv
CONSTRUCTION INFORMATION:
itiona worKIODienerrormed un ert ispermit—checka apply:
0HVAC Gas Tank �GasPiping _Shutters ❑Windows/Doors
Electric Plumbing Sprinklers .Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ � Jll iL_ Utilities: O Sewer DSeptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
;. fa'ie
Name Stl-uc;C GMT LLC 5fLuc;e E LLC 5
S
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LLQ
Address:'90 66)f, 19- ctm
Company: Sherlock
HornP5 0��1727`rea5��
City: "C1 � ealn State: 1:7L
Zip Code: �J�p� �_ Fax:
Phone No. 3O5- cl iD - Q koa3
Address: 10380 50 V
1tQ9eCPn1e_(1)r, Su'fC
City: Po( -I -St W6e
Zip Code:
Phone No.`>7a.' A0 ,
State:_
_ Fax: S (c o'q 13' 1a9 (7
b1310
E-Mail:
Fill in fee simple Title Holder an next page (if different
from the Owner listed above)
E-Mail: jft a ns 11^�CIUQ
Sri
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State or County License:
4 C Ct C 15 aJr
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGIN
Name: 0 Holt
ER: _
Not Applicable
e�r� n0v
MORTGAGE COMPANY: _ Not Applicable
Name:
Addr ss.
Address:
City: I I7P t On I
Zip:330I
rn 60:�4ln
Phone: '(0�3—'79gI
State:
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 ttorney before
commencing work t"ecordingkbur Notice of Commencement., ..
_ Signature oft7wn6/ Lessee/Agent
51gnature oT a older
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrurr99ent was acknowledged before me
MOVI#Abc, 20 /1 byQ
The forgping instrumery, was acknowledged b fore me
this%`r day %V/ha,, e:- /?bya
this'Ldayof .
of
1 e✓uFA X. /"rC �(,L6/GC
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✓ /�a
(Name of person ackn vie gIng )
(Name of person ackno ittdging)
(Signature No ublic- State of Florida)
(Signature of ota u lic- State of Florida )
/
Personal) Known OR Produced Identification ✓
Type of Identification Produced /2 iiyeij Lr�e
Personal) Known OR Produ�red entificatign
Type of Identification Produced Fr 1Jsi!/c✓1 /u
Commission No.GGJ�3 3�R
a JANNETTEMCOMMIg,gip.PER
IlBOER ssion No. JAff ffftM.PERLMUTTER
Notary Public, State o
Flodde ,�k Notary Public, State of Florida
Issior4 FF 173539
My oomm. expires Nov. 15, 2078
My comm. expires Nov. 15, 201
Revised 07/15/2014
REVIEWS
FRONT
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REVIEW
SUPERVISOR
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PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETE
/-;?•
INITIALS