HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLEINFOMUST BE COMPLETED FOR APPLICE 76N- TO BE ACCEPTED (X�
Date: "( 1 �� SCANNED Permit Number. Ncko-�Rs
}t� BY
St. Lucie County F2 FD
Building Permit Application APR 2 9 2016
Planning and Code
eRegulaionDlopment ivsices / PER,14177ING
Building and Code Regulation Division ✓// St. Lucie County, �L
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
Address: _17_,5- 6 �,- v s
Legal Description:
ENT LOCATION:
ckc'tker)
Property Tax ID#: 3�Zz-4f. lEr-pool-crop -7 Lot No._
Site Plan Name: Block No.
Project Name: eo c aLZ' P O Rn n 82 Ars
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�NSi Sit_ LL't� L��s �l 1�11-cr Ses1.t- o� ✓5� kckrvY
CONSTRUCTION INFORMATION: III
uua1wuJnwuc 1JVIIIICU uuueI uiu Perim—cnecrt do apply:
HVAC Gas Tank ❑Gas Piping Shutters ❑ Windows/Doors
Li Electric 0 Plumbing []Spri
Total Sq. Ft of Construction: 2- 1 . C/ 2Z
Cost of Construction: $
23Sd.0O
ers 11 Generators Roof
`5' 1
S Ft. of First Floor:
Utilities:Sewer E]Septic Building Height: _
OWNER/LESSEE:
CONTRACTOR:
Name Pr P,rrm� J I-tc Lr,sc;,.g LIL-G
Name:--L 7J O �(iAht fL
Company: S t GW t;0 n2tT i0
Address:_ IS`II Dr sY -Soo
City: r.,rc C.c 4pc GZ yr, State:_
Zip Code: Fax:_
PhoneNo._,-1,-30S-6G2-'2t�(o
E-Mail: I .1 6 V't _ mcN 19- 5 V c grvrsc ii s ^^
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Address: toZ L-G s z-s7y\^� rA P�k
City: PJ(LY -os wtj-Z Stater'1
ZipCode:3 tQSz Fax: 73-7 -0-'r0.6
Phone No.-'S 3 5-
E-Mail: S i WU C,5AA2 cr•0n O S� e \(-o i PV-4l-
State or County License: t: S / 2 00 ) 16 0
it value or construction is 5oZWU or more, a RECORDED Notice of Commencement is required.
a,0 fo� �7� 1`roli� 1-�3)C 2�� � `�,�Q-1 rS��uS►Rl
SUPPLEMENTAL CONSTRUCTION LIEN LAW I
MATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address: lkq-q S V'
City: froccr Sc . Uc't_ State:
Zip: 'wll r6i Phone: �KS�grc
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
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
commencing work or recording vour Notice of Commencement.
.ea
_ Signature of Owner/ Lessee/Agent
STATE OF FLORIDA
COUNTY OF �S-I— LA x C Le
The for oing instrument was acknowledged before me
thisdayof AA,P6 20.l by
Jil�A�rr� s
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF I— L.( A CA le�
The forgoing instrument was acknowledged before me
this c day of _ Cif I v i ( 20 E(�_ by
EdwcfA f 4)I I d WhCLcr_
(Name of person acknowledging) (Name of person acknowledging)
(,1� _Gt
(5ghature of Notary Public- State of Florida )
Personally Known t/ OR Produced Identification
Type of Identification Produced
Commission No. FM'1 ea
ff,�wA... "a'� KRI TIN LLOUDERBACK
!.'�7� j my r.c MMISSION #FF009222
���1 EXPIRES
Revised 07/15/2014 ,m s, Floridanr
(Sl nature of Notary Public -State of Florida)
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
14071
KRISTINA L LOUDERBACK
EXPIRES August 7. 2017
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
I
COMPLETE
1
INITIALS