HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMrLr i ED FOR APPLICATION TO BE ACCEPTED //
Date: SCANNED
SCANNED Permit Number: /!�11 er�z'y D'
BY
St. Lu a County
Building Permit Application RECEIVED
Planning and Development Services
Building and Code Regulation Division FEB - Z 2016
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 III
NltUl?UStU,11VI1'ItIJVtMtNL,LOCATION,ti�+,,r �� .` `" '�y'' _ ., ',
Address: V 22% 6 U S ( ✓I A S S pp-0_1: f) 2
Legal Description: 5 Cy- A--rT A- L 1+ 1 0
Property Tax ID#:_34Z6 —707�8c)o3— Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
I bETQILEDgDESGR�PTION'OF WORK: � c�'°it �� �.'r� "' ;,,�I
y�)<lZi L161i rLTO r3oK C ib�1 pN /3Vrt./ 1Yk3 �l \$T�/I� L�LPS✓T2 f`
CO`NSTRUCTION'�'NFORMATION¢
itiona wor to e e orme un ert ispermit
cneCk all appy:
�HVAC Gas Tank ❑Gas Piping _ Shutters ❑Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
i [l
Total Sq. Ft of Construction: 4141-L = `try S Ft. of First Floor:
Cost of Construction: $ 5-2-3 CC). Utilities:CnSewer Septic Building Height:
15IUglER/LESSEE
:.CONTRACTOR: y .-
Name plot-r'no
Name: 1=0 40u�_iePL�9CY�
Address: 3 I10 r4G1-1-er,yi, 61--,)0
Company: b' 1 611J C0ArlQ_c�c0i1
City: 04=:hron y State: V14-
Zip Code: '+/Sv3ci Fax: 3? 7--0e 6
Phone No.
Address: 102.Z c, .S 1✓ LE n.lorp 2✓-D
City: 1002r ST Luc i' 2 State: F L
Zip Code: 7%E4b 2 Fax: 337—p�0 6
Phone No.---S-3 S — 2 `t `t I
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: S i c- Q J Co ,n n a c<;k3n P S L- cLa
State or County License: u-,r,�, 1- - c.o
�r vno 0
u vdme ur construction is >[ouu or more, a nccUKUPW Notice of commencement is required.
SU0PLEMENTA[tbNSTRUCTIQwLIEN LAvlNFO]RMATION'
DESIGNER/ENGINEER: _ Not Applicable
Name: Po ok 4je,�c h
MORTGAGE COMPANY: Not Applicable
Name:
Address: taf%�Y 91 L,T moa.�' >T
Address:
City: Oa 2- f s-y t-Oc�e_ i;�- L State: F
Zip: 3 j q Y L Phone: -7srs—W9-Sf
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
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 attorney before
commencine work or recordine vour Notice of Commencement.
_ Signature of Owner/ Lessee/Agent
s
Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF CrI L �'G� COUNTY OF �'1- [Ax r Ie.
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this I dayof 20 )(pby this—Ldayof 9&�-) 20 Jt&by
LIA)CWd f)tAdyrbQcK Ek Qfri .tKopYlood(�
(Name of person acknowledging) (Name of person acknowledging)
(Si7 ature of Notary Public -State of Florida )
Personally Known ✓ OR Produced Identification
Type of Identification Produced
Commission
Revised 07
LOUDERBACK
EXPIRES August?. 2017
(Signature of Notary Public- State of Florida )
Personally Known v"' OR Produced Identification
Type of Identification Produced
Commission
KIJT4TJa A L LOUDERBACK
M COIISSION #FF009222
EXPIRES August 7. 2017
REVIEWS
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ZONING
SUPERVISOR
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VEGETATION
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MANGROVE
COUNTER
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