HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '7' \ Permit Number:
" RECENSO MAR 04 2016
SCANNED
BYBuildin Permit Application 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 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line nero,la I
PROPOSED IMPROVEMENT LOCATION:
Address: Ssy ESQ S ier�ercaQ lii�ce I to �oeI �i cuC�,i e %L acl�tfa
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front
"IS yaelo -IG5- 0005G— a(3a -
Back: Right Side: Left Side:
Lot No.
Block No.
(;DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION: ',I1�
Additinna wnnrrk t�narfnrma un ear v art is norm it::: MIt at nnn
HVAC U
Gas Tank ❑Gas
Piping
U Shutters U
Windows/Doors
Electric ISIPlumbing
Sprinklers
U Generator U
Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:. $ `_ -O v o o -- Utilities: Sewer 0 Septic Building Height:
OWNER/LESSEE:-
CONTRACTOR:
Name A 1r)a
Name: �i n VV.,
Address: �fsVG- n 1 -Ha/ # I to
Company: ,)6U zf (S rA,Ri a-q(1C.3 S'PlViC'2S
City: )lot-YS-L(uniQ Stater(_
Zip Code: 3Ng1;0- Fax:
Phone No.
Address:A) hlrfiC iVl1➢KDC
City: l C� t7o J1 State: (2L
Zip Code: _r�3(AC q Fax: 5(o l—(0Qq_ 9u1
Phone No. "501—(o.W-7-)U4
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: \(i h1C\l i Czi t-Zb1aC . com
State or County License: _0 I 152 3? 56
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ 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 re orded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult wit lender or an attorney before
commencine work or recordingy"r_Notice of Commencemei
_ Signature of Owner/ Lessee/Agent
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of 20 by
STATE OF FLORIDA � ^ �
COUNTY OF jjfn R[Z 1
The forgoing instrument � �w�a.,�s acknowledged before me
this_dayof ( t VO4 20 _L�2_by
1. Ylo NI
(Name of person acknowledging I (Namof person acknowledging)
(Signature. of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
Revised 07/15/2014
(Seal)
\GoI-d10 LA
"L 14 0-
(Signature of Notary Public -State of Florida )
Personally Known ✓ OR Produced Identification
Type of Identification Produced !1��p�
Commission Nm FJ-h35g3 "aALENAwOOD
N
�i OTARY PUBLIC
OW-15' Expires 12/15/2018
REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
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DATE
COMPLETE
I
INITIALS
I: SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: III
Not
Name
City:
Zip:.
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City:
Zip:
MORTGAGE COMPANY:
_ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phonc
I certify that no work or installation has commenced prior to the issuance of a permit.
_Not Applicable
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 re brded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult wit lender or an attorney before
commencing work or recordinLyour Notice of Commenceme
_Signature Owner/ Lessee/Agent Signature ntractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA�_ /�
COUNTY OF COUNTY C 1k1>7 ,aYI
The forgoing instrumentwas acknowledged before me The forgoing instrument was acknowledged before me
this _day ofOAn Oh 2011tc�20y this_dayof ri Yof� 20 by
(Name of person
Jacknowledging )
4 z2tL - fit
(Si(Si—g�ure of Notary Public- State of Florida )
Personally Known t- OR Produced Identification
Type of Identification Produced
I o Y-� i
(Nam of
person i knowle//dggiinng )
,C,etAf/!/Lt 0S
(Signature of Notary Public -State of Florida )
Personally Known ✓ OR Produced Identification
Type of Identification Produced
_ MADALENA QO
Y1c635 t{7 e� NOTARY W �a mission No.EE IFS35ya Commission No. F
OF
JA WOOD
PUBLIC
Expires 12/15/2018 "�17Et8r"•- E J1J1W rr1WZ14C
Revised 07/15/2014 `�O 3 _ O ` s Expires 12/15/2018
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS