HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAILIAPPII B1JIN10 E COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 7n"AN /Cfaa
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Building Permit Application FEB 12 2016
Planning and Development Services Public Work,
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
Address: WOW
U LYLAFN yl(� PINSW_.
Legal Description:
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A PAyll Or- 1J "z 09
6%,' ir LOT 14 rgcnO
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Property Tax ID #:
qr/ I - -S 17 - v000 - o0o /0
Lot No.
Site Plan Name:
0 C' a 7hv Sz--' V-14
Block No.
Project Name:
IOC&ANA- 50.1*
Setbacks Front
Back: _
Right Side: Left Side:
- DETAILED DESCRIPTION0, FWORK.`
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HVAC Gas Tank E]Gas Piping
Electric El Plumbing []Sprinklers
Shutters []Windows/Doors
Generator D Roof
Total Sq. Ft of Construction: V - S Ft of First Floor: I
Cost of Construction: $ IT% 000 Utilities: Sewer 11 Septic Building Height: /J00
OWNER/LESSEE: :,-
-CONTRACTOR..
Name Q6gft4 ('Orkh 0 6 RCSoc..
Name:
M1&441-M- &n'DLV4
Address:- /6400 5 OCAeVVIL
Company: I?wc#
City:-TfN3gd 1&4 — State:
LW�
Zip Code: 545S7 Fax:
Phone No. zm -18%
Address: 1740 /Vw &_Zaz§YP=n�
City: State: )zt_
Zip Code: ?q9Ff Fax: 100-47wy
Phone No. i6fx*-ao'!o
E-Mail: oS?_YW4WAG6?29C0MC4ST_,AfC1'
Fill in fee simple Title Holder on next page (if different
from the owner listed above)
E-Mail: ^6LI0aw"%, vwvo U. &A) e"
State or County License: G/r0tL'(1
If value of construction is $2500 or more, a RECORDED Notice at Lommencement is requires.
SUPPLfI+IENTAL'CbNSTRUCTIONtL-EN
LAW INFQRNIATION;`.
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:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count
yy 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
improvements to your prope
before the firsKTrlspectign. It
_ Signature of Owner/
to Record a Notice of Commencement may
Notice of Commencement must cor
tend to obtain financing, consVIf wi ler
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF -(3/ X1X1E COUNTY OF, G_L.1Gf�
ying twice for
on the jobsite
1ev before
The for��0J*J�g instrum nt was acknowledged before me The forgoing instrument was acknowledged before me
thi'L�%fd'ay of �� 20/�qby this�L'"f!"ay of CGGI , 20//v by
(Name of person acknowledging (Name of person acknowledging )
Sign ureof Notary Public- State of Florida ) (Signatures Notary Pubs- tate of Florida )
Personally Known .-' OR Produced Identification Personally Kn( OR Produced Identification
Type of Identification Produced Type of Identification Produced
78 % A�y ONO Commission No. 'i" III)
Commission No. .••P @b ="t ANN eA OND
MM MMISS ON o FF 173907 ?.e • :r MY COMMISSION Y FF 173907
•• a EXPIRES: December 7,2018 EXPIRES: December 7,2018
Revised 07
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