HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLET2r,,�R APPLICATION TO BE ACCEPTED
Date: 9-) - A Permit Number:
SCANNED
=' �" RECEV.7D SEP 2 72016 BY
St. Lucie County
No Building Permit Application
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:
Address:40161D 5. 5C_F..," DRIy ; �EIJSisN! Ae FL 34g51
Legal Description:
Property Tax ID#: %So*i - ib -A-Ckhbp - 000`0 Lot No.
Site Plan Name: Block No.
Project Name: IM(AA$j4;?, IT C_nOLb,nnijJryInn
Setbacks Front Back: Right Side: Left Side:
—Mechanical _GasTenk - V �''GasPiping Shutters ' ' Windows/Doors
— Electric — Plumbing — Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ L00.600, bb Utilities: Sewer —Septic
Roof Pitch
Building Height:
NO
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Ads:,
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Cit . »N i Stater
Zip Code: 3�9 9-7 Fax:77a �24
WID—
City: 1-il 4 G J�f
State:-f--(
Phone No.7 7;t 319 9/ 92-
Zip Code: 4 CI a I Fax:
Phone, No `% l .i O-p1 S' $L-1
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E-Mail:
Fill in fee simple Title Holder on next page
if different
E-Mail III S2 y 9
State or County License i [ I
I
as
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement Is required.
ON110 EU L: C MITI
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY:
Name: CIS M,-S-1SGU41EERIIJ C I i C Name:
Address: >I .... " SE p�g{ty� IRWA1 . -511 R Address:
City: $Tu-" Vtx 7 Stater City:
Zip: 3t}A4lo Ph'one'777i ,21-0 %ilmol Zip: Phone:_
Not Applicable
FEE SIMPLE TITLE HOLDER: of Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: hone: Zip: P ne:
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
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 concur'rency 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.
Signature of Owner4l-eCon(,rjictor as Agent for Owner
Signature of Co ctor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
�COUNTY OF J`�• uue %iE
The for oing instrument was acknowledged before me
� &-pi ew.6ek 20]1� " '
The for oing instrument was'acknowledged before me
'day
this day of . by
this f of 20J_L by
Mliog14F_ L Ll4GAL�1; T-1XIEA9URS2
Woo-kX ,F—L. SCst_L-A7rr>
(Name'ooff person acknowledgingg )� �'
/ i�ircF�'e.L Z- /CnI�L
(Name' ooff person acknowledging)
41/7ti Z-:..� -
(Signature of Notary Public -State of Florida)
(Signature of Notary Public -State of Florida)
Personally Known - OR Produced Identification
Personally Known OR Produced Ide lot
Type of Identification
Produced VERNON L' R00t
Type of Identificatio VFRMOIT4 OOT
Produced NelaryFeblk - 6lNe of floriAa
r ubik - Slab of FIN61-
' MY Cortim. Ezpires;bby t7,ilOt7
= •E Comm. EzpiresMay 17, 2017
My.
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Commission No. =' • ;
Commission # EE $67441
Commission No. ^ Commission. # EE'867446
BOAMI fliM* Now NWAUL
mnt`• 'fionee,^•^..."4ational NotpY —
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW-
REVIEW
(r
RECEIVED
Id�'ly
aS
DATE
_
COMPLETED
Rev. 7/2014