HomeMy WebLinkAboutBUILDING PERMIT APPLICATION0
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ALL APPLICABLE INFO MUST BECOMPLETED FOR APPLICATION TOBEACCEPTED MAsl�rz �LUCq[cil0-Dclr7/
Date:3% Permit Number: �ro\damd t
RECE1VrD OCT 612016
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
S(;ANIVtL
BY
St. Lucie Count,
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
'PROPOSED IMPROVEMENT LOCATION:
Address: %b3c>S S 1-kLo o SAIIJi bu&(6
Legal Description:
PropertyTaxlD#:3���'�O�'
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side:
Left Side:
DETAILED D kRIPTION'OF WORK
T:OSrA I I A r90P of TWO IC.-r~ tAX0, iN65 K ACJF-tom Spec S4lcL-rS
CONSTRUCTION INFORMATION:
Lot No.
Block No.
Muwuu1101 wLin w ue eu Unucu uuucI LIM Pennu—cnecrt au dppry:
❑HVAC.: Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
❑ Electric ❑ Plumbing ❑ Sprinklers ❑ Generator ❑ Roof ❑ Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ i 000.00
So. Ft. of First Floor: _
Utilities:11 Sewer ❑ Septic
Building Height:
:OWNER%LESSEEt
CONTRAC11 TOR;
Name T=AC.t;`C12AC,
Name: ,1DA2¢.s." t7e9p�tJ
Address: 081 3o5V5 i4"!y I
Company: ThSo-Pi*J1JAI Ale-7DLt02
City: Po o:r :5'1WC.rE State: i_1-
Zip Code: 34g57- Fax:
Phone No. C CL Tofii iA) (A0-0(,tct bTG0
Address: 115741 LJQ ( LDUQ.r tjaay .
City: L OxAInAtL Lib State:4
Zip Code: 3 '4-70 Fax:
Phone No. pzyq
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: Al PyA G & elHA'L , L.OH
State or County License: CA C,19,110 '15
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMAN TALCONSTRILI btN LAW INFORMATIONc"`
DESIGNER/ENGINEER:
_Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
Applicable
Name:
Name:
_Not
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 Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in con list 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.
STATE OF FLORIDA
COUNTY OF Sk. LVc.��
The for Ang instrument was acknowledged before me
this day of ny7� 20 Vz _by
STATE OF FLORIDA
COUNTYOF fa-lrv, 13eaC,6 rOr:n
The forgoing instrument was acknowledged before me
this 31 day of O C ivher . 20 �i by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pul
Personally Known
Type of Identification Pr(
Commission No.
Revised 07/15/2014
REVIEWS
INITIALS
State of Florida )
FRONT I ZONING
COUNTER REVIEW
(Signature of Notary Public -State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
1+A19MELLE SORIANO
Notary Public . State of Florida
My COMM. Expires Oct 16, 2020
SUPERVISOR ANGRO
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