HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J
Date: Ito p Permit Number: I t o ci
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.EIS GIto�N� BYRECEIVED
St.
LUcieCoanti-
Building Permit Application JAN 21 2016
Planning and Development Services PERrJIITTING
Building, and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial_ Residential
PERMIT APPLICATION FOR:- To Select from dropbox, click arrow at the end of line
PROPOSED IMPROV ENT LOCATION, 3 ' ' 'g,
Address:_t S. LlS= - - 2a a
/�yyq� [
Legal escription: �e A7-rA L,�®/- 1Cq1 OCI [cl �®IpeCc
Property Tax ID #:
U IV
0 Lot No.
Site Plan Name: o r Block No.
A�
(3 Project Name: 1'1&za_
Setbacks Front Back: Right Side: Left Side:
DETAILED;DESCRIPTION_OFiWORK?�
F
nen- I ihl-ems ivLonwv,e�, f
,
CONSTRUCTION INFORMATI'ON,`:;
a
Aaaitional work to be nertormed under this permit— check all apply:
❑ HVAC Gas Tank ❑Gas Piping _ Shutters ❑Windows/Doors
Electric
Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construc n: S Ft . of First Floor:
Cost of Construction: $' Utilities:�Sewer Septic Building Height:
011VNER/LESSEE Tr. a
e{{GONTftACTOR f j
777
ilMVilGs>`
Name i LC
Name:
Address: 3-7 ove G/J9
Company:
/1
City: ii eli /L State:
Address: /��/
Q AWy
Zip Code: _�,7J` 7 Fax:
City: G6f,5i/�_�r�,ef State: ,I
PhoneNo._r%7o2-3 _3-SZO?
Zip Code: �311211/ Fax: 35o?-% B�o(o4
E-Mail:
Phone No. �JSoZ %a8—l//9
Fill in fee simple Title Holder on next page ( if different
E-Mail: ,11P� /rir r 7<�/ng S/ohs lip
State or County License: D0307
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION "`
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: P e:
State:
City:
Zip: one:
State:
FEE SIMPLE TITLt HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:
City:
City:
Zip: P ne:
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 vour Home Owners Association and review vour deed for anv restrictions which may anniv.
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 OWN . our failure to Record a Notice of Commencement may result in your paying twice for
improvementst our p ope ay. A Notice of Commencement must be and posted on the jobsite
before the f' inspect' n. If you intend to obtain financing, cons ith le n r or an attorney before
comme work or ecordin ou Notice of Commenceme
Signs re of Ow f Lessee/Age Sig Lure of � ctor/+L/ic �,se er _
TE OF FL IDAL n �� e;--I?
STATE
F�uJa COUNTY O ' a36
The in instrument was acknowled ed� ppe�fore menstru Itwa ck o edge%d efore me
this dayof fs UH 12 Lf, 20.LC�b .of�� : / b
(Name of person acknowledging)
(Slg�6't't� 0- 1. .�
of Notary Public- Stat f Florida )
Personally Known OR Produced Identification
Type of Identification roduced
n J; �7a� �g.19o� NOTARY F
Commission No. �1 �gy' I)io STATE OF
�+' Comm#'EE
Revised 07/15/2014
ng
Notary
Known_)UOR Produced Identification
ntification Produced par VALERIE A. TEICHM,-.
395��Q , Fo,NOTARY PUBLIC
n No. ,lo f@Jf)TE OF FI.Ckr'
W Comm#EE1309t
"RE 1§1 Pknlrnn 1 197: -
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
Mor\
Name:
City:
Zip:.
ne:
Noi Applicable
State:
FEE SIMPLE TITLE HOLDS • _ Not Applicable
Name:
Address:
City:
Zip: Phone:.
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: one:
BONDING
Name: I
Address:
Phone:
Not Applicable
_Not Applicable
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count 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 OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your pro y. A Notice of Commencement must be recorded a ted on the jobsite
before the first inspe
xmn. If ou intend to obtain financing, consult with I r or an torney before
commencina wo or recor Ina vour Notice of Commencement.
of
STATE OF
COUNTY}
The forgoing instrume t was acknowledged before me
this _- day of � dii ii K/ . 20 �Oby
STATE OF
COUNTY 4
The forgoing instrument was acknowledged beforb me
this Z day of 20 a. by
(Name of pEdson acknowled mg) (Name of pers6n acknowledgInE0)
( nature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identificat on Produced
Commission No.
VALERIE A TEICHMANN
Revised 07/15/2014 ^d EXPIRES January 27. 2020
' •��''� Fb1EaN
�1'Snnw•x�.cn•n
(Si nature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of ldentificatiWProduced
Commission No.JQF97�� (Seal)
My COMMISSION # FF953120
EXPIRES January 27. 2020
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
(a0 ('
Oa4 $
INITIALS