HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE C
! '' Date: l7 - 14
D FOR APPLICATION TO BE ACCEPTAW ✓✓KK11 _
SCANNED Permit Number: I(0 01 -(SW)
St. Lucie County
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Application
Commercial ?< Residential
RECE.
JAM 1,9 2016
PEpigiTTING
St. t.ucle coin FL
PERMIT APPLICATION FOR:
PROP,C,Eb,*I ;R,QUEMENT LI GATION "tr 3 r �r , fi ; f .
11
Address: r JE+✓fEi✓ QERC/fj
Legal Description: L9 to (0 / D . (J C%V_fFA) cLDle.
Property Tax ID #: 3SogIlloo o 9- o00.3 Lot No.
Site Plan Name:
Project Name:
Setbacks Front rf/4 Back: Right Side: LeftSide:
Block No.
Mechanical Gas Tank _Gas Piping _ShuttersWindows/Doors
Vf1ectric 1,41 u m b i n I _ Sprinklers _ Generator ✓ Roof /W4 ww
Total Sq. Ft of Construction: % "Z80 Sq. R. of First Floor:
Cost of Construction: $ �%, 0Oo Utilities: —Sewer t/eptic Building Height:
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�;WNER/LESEE#";, r
GON�RACCOR
Name
Name: /l�lRsHrF1V /r%R�P/S•�
Name:
Address: P 0. Aox- /�/060
Company:r.,m�E? -rac �x.✓>ngGw�✓tT
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City: /54ec// State:_
Zip Code: 33Vo 8 Fax:
Phone No. 13,1 S08 -3s37
Address: !)o9 _£•E. $tA -Weed
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City: Sett - t
zip Code: 3 5(99V Fax: 72a
Phone No -aao--?Ykg.
State: F/
• a83- 0?85�
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E-Mail: //; 7 GOh/Zarc7, -even
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above) N/k
E-Mail M/V[ a-LViscn/ L-M MD wry4uRaf.
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State or County License 6 is r,
If value of construction Is 2500 or more, a RECORDED+Notice of Commencement is required.
UPS f iVIIN�LG®TR tl®fENLAIN�(FORiVATIQ�"
DESIGNER/ENGINEER: _ Not Applicable
-MORTGAGE COMPANY: Not Applicable
-
Name: do? Af0W11_gcrARE--=---
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Address ,kS1 - . dC&gei 8AvW
Address:
City: State:
City:-5iAg4- State: f/_
Zip: 22aA• Phone g7A-1A0-eIVii
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY:/ Not Applicable
Name:
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 any applicable Home Owners Association rules, bylaws or an covenants that may restrict or prohibit such
with
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
commencing work or recordingyourNotice of Commencement.
Slgnatt.0 of caner Lesseed ontractor as Agent for Owner
jj
Si natur of Contractor ense Holder
r
STATE OF FLORIDA
STATE OF FLORID
COUNTY OF S L.. a .
COUNTY OFF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _" day a, ,20 y
this1l/1dayof 20l�ity
�of3C9
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(Name of person acknowledging)
(Name of person acknowledging )
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(Signature of Notary Public -State of Florida)
(Signature of Notary Public- State of Florida ]
Personally Known OR Produced Identification
Personally Knownced1jidentification
Type of Identification
YP
T pe of Identification LASHAHN
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Pro_ ced I IN�M
a, „tida
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oduced INGRAM
" �' N ry Public _
State of
MYC omm'€xP res Dec 20,120 g
".',Fo,r
Commission No. :c Dec 20Io20
° . _ �J
mmi55i0n N0. oa? ��Mon # IT 177
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Commission # FF 177249
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REVIEWS FRONT ZONING SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER REVIEW REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
V
DATE
COMPLETED
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