HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _ Q
Date: Ia-��'IS SCANNLV Permit Number: ISIi.,-l/� T�1 c) 1�
-- BY
.�.F St. Lucie Countt R EC E RIE D
Building Permit Application DEC 2 2 2015
Planning and Development Services
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie County, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial 1t, Residential
PERMIT APPLICATION FOR: 11Ccc?SS ��4����STIdIGr Accc�sS
P.ROPOSED'INPROUfMENTLOGATIONy+`. a'
Address: TlU ( '.CSC F'A J T�)'2-
Legal Description: .S, /x j
Property Tax ID #: ✓7b UZ < -0 I 23 n 1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
_Mechanical
_ Electric
_ Gas Tank
Plumbing
_ Gas Piping
_ Sprinklers
a
_ Shutters
_ Generator
Windows/Doors
Roof
Total Sq. Ft of Construction: f Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
OV1fNERJLESSEE; ,=w
CONTRACTOR } ;w
Name I��v''i`I-CUSS I--eL4.4C) rn/C.
Name: CePt�otL4�'
s
Address: 'q epCL.4 -J i ESE-
Company: n n1�2[> I ,7C9
C'29EQ
,City:-_\,-,-,,se;l�t, State:1:�-L-
Zip'Code: a4—i !n Fax:
Phone No. "l'12. 2,29 ` 3-21
Address:l`2�/1.�'�/�n5o�(TGeo✓�
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City: rL, . / „r i
Zip Code: Fax:
Phone No '1'7
State: P t-'
1 12C�1'lK3I
E-Mail:
Fill in fee simple Title Holder on next page( if different
from the Owner listed above)
E-Mail CDa1Go¢F�t�Utu� t rfL+CoRP
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State or County License 9B(
If value of construction is 2500"or more, a. RECORDED Notice of Commencement is required.
SL), LIF VONTAL CONSTRUCTION LIEN LAW,INFO'RM,4TION
`' n ,, firer + • P 9a : $: � °
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DESIGNER/ENGINEER:
Name:�L), LkJ9.0 C_1
Address: /,� )
_ Not Applicable
/1jC _
u n.o2r�5?
MORTGAGE COMPANY:
Name:
X,, Not Applicable
Address:
�v e� S City: .FS[-C_)c .d
Zip: 3tF Phone 772
State: f C...
7 Z5 49 i
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
lot Applicable
BONDING COMPANY:
Name:
_ of Applicable
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 con, 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
commencingwork or recordingour Notice Of Commencement.
l V'4; .
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Signature of Owner/ Lessee gen
Signature of Contractor. License older
STATE OF FLORI +
STATE OF FLIORI
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COUNTY OF. l 11C IE_
COUNTY OF
�U C 1 F_
The for oing in ment was acknowledged before me
n
The forgoing ins ment was acknowledgedbefore me
day 20� by
tth'isII day • 26j5 by
this ;8 of
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11Iniri4 Vl2Y tAo, C)nnh II
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( amyl ` e� of person kknowledging
(Name of person acknowledge
g )
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(Signature of Notary Pu 1c-State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
-1
Type of IdentifiL
Cr(F
Produced ,L °°"" KAREN S. N=TTIELS
ced
Commission a FF 115
Commission NO. �Seall), Commission Expi
37
ego ission No. 'J
KA EN S. NIELSE
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_ E.moi ission N FF 1156
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`:••`� June 12, 2018
�� W Commission Expire
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June 12, 2018
REVIEWS
FRONT
ZONING
SUPERVISOR
PLAN5
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev.7/ZU14
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