HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE C( ^ ,_ETEaFOR APPLICATION TO BE ACCEPT /,
Date: V • 7/& SCANNED Permit Number: ,�i Vl
BY
St. Lucie County RECEIVED
Building Permit Application JU1d /6 2016
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 III
Address: IiA` U'D
Legal Description: !30_4\ i5hyx V k �Lo_o Q C CC7�m,vi w vn AssOcc�i +are , I n C
Property Tax ID
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Z laci� Lqar4le o[oor-S i ke -Fo
cCc�5 �� -
I IVI, IIUM Y„UC, LIII3 F,Ci 1 1 1 IL-W
HVAC Gas Tank as.Piping
Electric 0Piuinbing Sprinklers
11 k'e Co�c7 *-
Lot No.
Block No.
x7
..rr.y GQ2A5z..
Shutters �VAndoays/Doors
Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:*$ `BOO D : 00 Utilities: 0 Sewer ®Septic Building Height:
OWNERJCESSEE i, y
'CONTRACTOR
>.
NameSourt6+SMLa,.t_vC� agso!
a 1. _
Name: J_ AA,07
Address: G.1(-O-D i-64 ,6ozAL rr"&* %0b
ijJ opi
'
Corppdnyti' f
` D
I CLn t01'�Re �Aafs, LL C
City: Yor ST ILA c&e . State: ;Fi
Zip Code: 34970 Fax:]1D-33Ca -)' i(cj�j
�, i%it
Pddre s
i� ��✓P
City„61�fL- .iJUQL/P Stater
Zip Code:3(l9S3 Fax: N/A
Phone No. (77a) 37D 4(
Phone No. 7?1-873-raolLf
E-Mail: cc C4.-r..L._Q Hr.(eG.OrP
Fill In fee simple Title Holder on next pageG( If different
from the Owner listed above)
E-Mail: JVQ f IAWto
XAAV# . C6,1
State or County License:
e9ts ? 3
n vame or construction is sz5u0 or more, a RECORDED Notice of Commencement Is required.
SfJPPLEMENTAL C0NSTRU0 N ;l IEIV LAW INIF
ATION y
..♦d-...-<_�,:9 t+_„v",8 % d}rx �S�as? .l'Po- ..�.� .x.rt ,.'�x�n
.,,, .-- a ,.... �e£....`�4 f,,._',
; o.•.'4._+a+
DESIGNER/ENGINEER: _/ Not Applicable
.e 3.�•k
MORTGAGE COMPANY. Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
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 per 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 concurren'cy'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
_ Signature
STATE OF FLORlIqr STATE OF FLORIDA `.
COUNTY OF 1. IA AC �Q, COUNTY OF
The forgoing instrument was acknowledged before me The f rgoing instrument was acknowledged before me
this ay of I o J 20 Lby this day of � LWll�-, 20 Lla_ by
,L)an LA>5Ug_0_ _ � Mali .. , L �)P:z
(Name of person acknowledging) (Nam ff person acknowledging )
(Signature. of Notary Public- State of fjbrida )
Personally Known OR Produced Identification J
Type of Identification Produced
Commission No. • Na . , _*• • REATHEBa
Revised 01/15/2014
(Signature
State of Florida
Personally Known OR Produced Identification
Type of Identification Produced e i ,
. (Seal)
My Commission -Expires
7- June 1-2; 2b18
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER .
REVIEW
`REVIEW
REVIW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS