HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:'_ �I.HIVIVEQ Permit Number: U
Luce County
VH i
Building Permit Application AUG 2 3 2016
Planning and Development Services PERMITrING
Building and Code Regulation Division St. Lucie county, FL
2300 Virginia Avenue, Fort Pierce F134982
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:
Legal Description:17 sw l(i of tow (u 1PCS OrarsAT AV 4JW A IDiC r 4r O�W IPCC yinrit UwdY locC r�rin OS
innr 2210-2141 �ti�-zgtoY Na-use '31a� IzRA-(Wt we Rcl(Dr uaaa loaiu io�ct soil
Property Tax ID #: ?_7�12.-7_5' 1 -G905- e99 -S Lot No.
Site Plan Name: Block No.
Project Name, FjJIDT 11)2'L
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WQRK;
ton S far
i i, O i Fug 13.O
GONSTRUCTIQN INFOR'MgTION:
ions worK to e e orme under s perms -checka apply:
HVAC Gas Tank as Piping _Shutters ❑ Windows/Doors
�Electrir O Plumbing [:]Sprinklers 0 Generator ❑ Roof
Total Sq. Ft of Construction: _ S Ft. of First Floor:
Cost of Construction: $ 97� . Utilities: Sewer Septic Building Height:
OWNER/LESSEE — _ - .
CONTRACTOR: _
Name Cr-,T AR(aah Wi kk
-rr/AVQI 0_406CUC
Name:10kA it, `&
Address:')00 HOC S'-1y'=f9
City: Stater
Zip Code: LiOFax:
Phone No.
Company; bimo_4c rn�
M-nnicec Cauv
Address:'
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City: L1 State:
Zip Code: _-*J E' Fax:G3�7�35�-82(
Phone No. 20(I -8I,
E-Mail:
Fill In fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: 1)« Trr1?,C,(o9. C/31 to
State or County License: S' MC. Agog - l
I
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. 11
SUP P,LEMENTA`LrCOI�STRl�1CTION LIEN,LAWcIiVFORMAT,IO,N
,'
DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
/Not Applicable
Name:
Name:
T
Address:
Address:
City:
State:
City:
State:
Zip: Phone:
Zip: Phone:
i
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 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 inpection. if you intend to obtain financing, consult with lender or an attorney before
STATE OF FL9RIB l ci IYI cSS[G SThrt r_.OF FLOR.I4A�L�
COUNTY OF J(A bK � COiTNTY OF M
The g�IIng instrument was acknowledged before me The f rgoing instrument was acknowledged before me
this Aay of 20 Eby this day of 20 (U by
Sl\er cj L. t3JC.ALe Louie, 1wa' lit
(Name of person acknowledging) (Name of person acknowledging)
wnnut
131
(Signature of Notary u lic-State of : )Vitt (Signature of Notary Public -State of Florida )
Personally Known t,'*" OR Prodi ldent'Ifraiti _ Personally Known �,/- OR Produced Identification
Type of Identification Produced = cA ESE' Type of Identification Produced
O
Co Sept al) 0L Comm' (Seal)
��iAflnpa$IQ(}E_YnirRA^ 'IY„2O4o: )PV
.� J `���� =o`er 4�n Notary Public State of Florida
-- - rrr/tttll l I tt0,� ?orw P MY co missi nFF 901554
Revised 07/15/2014 _ _ _ _ _
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