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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMw�c�TED FOR APPLICATION TO BE ACCEPTEI I -1� ^ Date: SCANNED Permit Number: U� k � BY <_ St. Lucie Count% Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772)462-1578 PERMIT APPLICATION FOR: MOM Address: Building Permit Application Commercialy Residential Legal Description: 5j2 c. 72 Tn w>7SL s)O 3 66 RQ .4 y O E RE(D'EIVE0 JAN 1:.9 2016 PERMITTING St. Lucie County, FL PropertyTax ID #: 3 4 sta 12 L/ o pn 3 6on 2 Lot No. Site Plan Name: Project Name: Setbacks Front Back: Right Side: Left Side: 'K2cov%54Yv 6 E)t! 4f,44 (fJ-0C -r;C � _Mechanical _ Electric Gas Tank ✓Plumbing Total Sq. Ft of Construction: Cost of Construction: $ )Soo perm¢-cnec Gas Piping Sprinklers Shutters Generator Sq. Ft. of First Floor: Block No. Windows/Doors Roof Utilities: _Sewer _Septic Building Height: ®tgNERY%LESSEE: C®NTRP;CT©I: Name Yl ])C47r&n LLB Name: P1rtAc L iilEi-AntzSw Address: .73'7o S v5I Company: Pt fAn e�u5w 6?n5'F ffML City: PSL IF. State: FL- Zip Code: 3144 5- - Fax: PhbneNo.'7'7a �a51—.�638 Address:'2$4O iehv Some Dr,,c City: fT_ RltA � Zip Code: 3Y�1457 Fax: Phone No 772 aDl —7% State:-i- `77Z. q6S 7873 1-7 E-Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail GQ i �ru n C h,_j4 i nt a o L . Low State or County License R 290i) 3 6 a I If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. 16 14 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 is in which 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 commencingwork or recordingour Notice of Commencement. -41, Z 19 �� Z�'� - ev. P L -M� i*AL C4 STR Y N L� DESIGNEnnR/ENGINEER: _Not Name: LCY7it- �- M�ha r� Applicable MORTGAGE COMPANY: Name: _Not Applicable Address: gbl� lie 4wev-c Ow•e-- Address: City: �( r-t C Zip: �ysaz Phone'77Z State: 60 �751 City: Zip: Phone: State: FEE SIMPLE TITLE HOLDER: _Not Name: Applicable BONDING COMPANY: Name: _Not Applicable Address: Address: n/ ` City: City: �9 Zip: Phone: Zip: Phone: SignaturEf of Owner/ Lessee/ ontractor as Agent for Owner Signatureo Contractor License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF � 1s.- - The fg{going instrument was acknowledged before me The forgoing instrument was acknowledged before me o(f� 20� by thilsrnK this �� day o0im NA) by yday �\ ' 1\ r-Q �) y 11Ql tMSLD1f (p ��2�0_(� � . m \ J �.alY1R�Y-x (Name of person ackno ledging) (Name of person acknowledgi g ) ignature of Notary Public -State of Florida) (ign ture of Notary Publi -State of Florida ) Personally Known � OR P o c. Personally Known - rodu¢o1SM�NW�ipM Type of Identification ,Y,aV, LASHAHN State off FIN d Type of Identificati ;•`:a` "'%s`� ., Notary Public - State 201g 'O Dec 20, • Produced ••'�"a a<%'•, Notary PuClic - Tres Dec 20, 2018 Expires Produced Comm. FF 177249 MV # _ � .? My Comm. Exp FF 177249 # - = Commission Assn. P' Nat nal Notary �@ sion Commission No. ssn.`CommissionNo. He n National Notary A �%F���°•' eondedlhrou of �;,. Son ed Ulnr p REVIEWS FRONT ZONING SUPERVISOR PLA VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW —REVIEW REVIEW REVIEW DATE 11^- RECEIVED )V DATE / � Z%yrr4 COMPLETED