HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: V. I-Q,1% Permit Number: �GC51-43163
�— RECEI` 7 JAN 121016
• _ _ _ SCANNtL,
Building Permit Application BY 'Ot)E6
Planning and Development Services S• LUCIe Crn iniV
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: Sign
PROPOSED IM_PRO_ VEMENTIOCATION
Address: S . Irl Arl S1 ( u_e I e F
10�-1
Legal Description: Se e i4T7i¢GLi�cf'
Property Tax ID #: Ici
3 ( O D ' —0 I' %Z'IO ' UCp of No.
Site Plan Name: HimAip
po Tr -a Block No.
Project Name: lJ 7y/G 4 l&L�nM'Y r
Setbacks Front Back: Right Side: Left Side:
DETAILED; DESCRIPTION 6F'W0RKJ.
`.
FCONSTRUCTION INFORMATION:
riuunionaiWUrKwue
1HVAC
eriorrneu
Gas Tank
unuerinis
,perms-cnecrcau apply:
❑Gas Piping In Shutters
❑
-
Windows/Doors
_
Electric El Plumbing
Sprinklers
O Generator
Roof
Total Sq. Ft of Construction: 22?4
40 r 32 S
S Ft. of First Floor:
Cost of Construction: $ I SOU Utilities:InSewer ElSeptic
Building Height: zD r
OWNE/LESSEE`_
R
CQNTRACTOR
Name <b
. Name: R
Address: L{-Z.32 ��Glrj t"Alfe i�iA_Vr
Company: LA)
_ l S
City: ..°iP"('IES,e n Stater
Zip Cdde:, 419J'1 '7 Fax:
Pho'r a No. 11"�,- 3�3 - 5',O7
Address: r 4_ l --b o
City: E
Zip Code: 3ql 4q
Phone No. 3J5cP- -799-111
State
Fax: 35a'709 (o�o`�
q
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: &
S ..0
State or County License:
3 0
2-Ct 5-2
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
S1JPPL-EMENTAUt0NSTRUCTI0_ NIIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone:
State:
City:
Zip: Phon .
State:
FEE SIMPLE TITLE HO R:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 thepermitholder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an 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 ma u t in y ur payin
improvements to your property. A Notice of Commencement must bejeCorded and posted on
before the first inspection. If you intend to obtain financing, consul ith lender or a attorney
commencing work or recording vour Notice of Commencement /
_ Signature of Owner/ Lessee/Agent SIgnaf6re of Cc
STATE OF FLORIDA STATE OF FI
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The fjr( d.oip># (nstrument was acknowledged before me
this _ day of 20 _by this ay of 20 by
1 s Le
(Name of person acknowledging) (Name ofRersoh acknowledging
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. (Seal)
Revised 07/15/2014
(Signature of Notary Public- State of Florida )
Personally KnownOR Produced Identification
Type of Identificatt n Frroducedr��/ `
Commission No.0'6 t��, „J (Seal)
for
VALERIE A. TEICHMANN
STATE OF FLORIDA
Comm# EE139550
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
/
COMPLETE
�N6
INITIALS
,SCUP LE ENTAt`CON$T�CiCT10N11E1
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: : Phone:
FEE SIMPLE TITLE H El
Name:
Address:
City:
Zip: Phone:,
c.r r Jz x ti `� - {�{ aS".fi x-r c �2.•wT' n.�+'rb z +nI` s i •.
.,...,�.t.. .�....� cw,�m� � a-. ,h,�':. .-� r �_.-Hr•+-��os„«I+tin5r.3.''azu>%taC+.3t:L
N.OL rAppncaole 1, MORTGAGE COMPANY: _ Not Applicable
Name:
Address: _
State: City:
Zip:
Not Applicable BONDING
Name:
Addres ' _
City:
Zip:
e:
Phone:
_Not Applicable
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 permitllolder 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
improvements
before the first
of
OF
�Yo r failure to Record a Notice of Commencement may r n your paying twice for
our. perty. A Notice of Commencement must be re ded a d posted on the jobsite
oecti n. If you intend to obtain financing, consult lender r an attorney before
or mcordina vour Notice of Commencement.
rA
The forgoing instrument was acknowledged before me
this _L1 day of ��ar.`i �c�, 20 jjGby
(Name
(Signature of Notary Pubic -Stale of Florida )
Personally Known tk /�/ OR Produced Identification
Type of Identifications Produced
Commission No. 3 Z (Seal)
a' VALERIE A TEICHMANN
' ' My COMMISSION # FF953126
Revised 07/15/2014; •++ EXPIRES January 27. 2020
.; n.•�
•Gd81.1] F iC NnGrybenro.nnm
STATE Q4nORIDA
COUN,VrOF Lt�K a
The forgoing instrument was acknowledged before me
this 11 day of 20 ff�_ by
(Name of p6rson acknowled ing )
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identificati oduced
Commission No.
VALERIE A TEICHMANN
EXPIRES January 27. 2020
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
.4 O1-O
INITIALS