HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONbvlz-5 687-5
LETED FOR APPLICATION TO BE ACCEPT,'-
-All APPLICABLE INFO MUST BE
Date:
Permit Number. I u cl - um�
�I;HNNED ..
" - St. Luce Co a ntA I,et'yl1a .., RECEIVE®
Planning and Development services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Building Permit Application JAN 0 b 2016
PERMITTING
St. Lucie County, FL
Commercial Residential
0
Legal Description: l700p1- 0 P S�Axl ptlo se'lv A
Y•s G..IIo.. csi„1.�- Ncn-?�.- eus�'�s �l�rnd��,c l�i,s�
PropertyTax ID #: J Yls 76 2- O'b O I O S— Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
_Mechanical
Electric
_ Gas Tank
Z5FIumbing
Total Sq. Ft of Construction::
Cost of Construction: $ --CY()
_ Gas Piping
_ Sprinklers
au inat appry:
_ Shutters
Generator
Sq. Ft. of First Floor: _
Block No.
Windows/Doors
Roof
Utilities: _Sewer _Septic Building Height:
OWNER/L€SSEE:
GO NTRACTOR:
Name 6 •ram
Name: K% c 4 v ro p ,fir'
Address: /%2.�- Csti%ari' �,o/h
Company: r76+rvuA_c-PIU 1/C
City: j/%� s State:kA
ZipCdde: sY5JV Fax:
Phone No.
Address: I? z r G-eH+;Iti &A
City: S State: —L
Zip Code: Fax:
Phone No."70 t /J� y
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 19i V+✓28-sr lcmil-i'�_(j� o% cats-,
State or County License ac/3 r
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRU
N LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY: _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 swim%ping pools, fences, walls, signs, screen rooms and accessory uses t not r non-residential use
WARNING TO WN R: Your failure to Record a Notice of Commencement may sul n your paying twice for
improvemen to )Our property. A Notice of Commencement must be rec ed nd posted on the jobsite
before the f' st i pection. If you intend to obtain financing, consult with ` nd or an attorne�rbefore.
commenci wok or recording vour Notice of Commencement. / �/
1 14
. / IX, // / ��'
Signa a Owner/ Lessee/Contractor as Agent for Owner
Signature o acto / i ens H Ider
STA E OF FLORIDA
STATE FLORIDA 1
COUNTY OF
COUNTY OFO
The forgoing instr ent was acknowledged before me
this day of, 20J10 by
The forgoing instrument was acknowledged before me
this day 20410 by
_�_ of SM
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- Stale of Florida)
(Signature of Notary Public- tate of Florida )
\v
Personally Known OR Produced Identification - '
Personally Known OR Produced Ide ation
Type of Identification
Type of Identification
Produced GPPM As
fwtl 9
Produced ARP E\0t�0a,
20�9
Commission No. Op5\\ \ao 20.20\
5\\PNN S,'S"F'°—oC' 0
Commission No.
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REVIEWS
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PLANS
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MANGROVE
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REVIEW
REVIEW
fi%4
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Nev. 7/2014