HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
tAL APkICABLE INFO MUST BE COMPLc rrJ FOR APPLICATION TO BE ACCEPTED
Date: 5(;HNNED Permit Number: I
y,e, aBYSt. Luce County 696E®
Building Permit Application ItCIFIIf V%
Planning and Development Services
Building and Code Regulation Division MY 2 0 2016
2300 Virginia Avenue, Fort Pierce FL 34982 PERI,,IING
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ResidertiaQ.
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
,PROPOSED IMPROVEMENT LOCATION:
Address: / 0-0 SO � 061q ,�`�r� -9 -/� T _ �_ /
Legal Description: zog-L� C /( o U 141, ' /kl�o�( L'L t� C,,".4), i+.c.ccti
alyLz „ 1I S gun
Property Tax ID #: Z/'S o 2 — jD q _ 06 r 7 —e&V Lot No.
Site Plan Name: Block No.
Project Name: skm_e//� &y:�4i
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: "
TablUe Are AfilU P6C � 1 s X et;c ,Qce%l i'A_J
� O
IZONSTRUCTION INFORMATION:
Hamnonai worK co ci errormea unaermis perm¢—cnecK an apply:
[JHVAC Gas Tank Gas Piping ❑ _ Shutters Windows/Doors
11 Electric El Plumbing []Sprinklers nGenerator Roof
Total Sq. Ft of Construction: .y - S- ICG S Ft. of First Floor:
Cost of Construction: $ �JO 7%5 � Utilities:ln Sewer E]Septic Building Height:
.OWNER/LESSEE:
CONTRACTOR:.
Name i'QK 6)vu klvw L L C
Name:
Address: Q 860 5 • 0649-14w Q4-LwQ
Company:
City: f 2'A a-9-� Qoyz eC_ State:
Zip Code: 3 C 9 9 !� Fax:
Phone No. '7 Z- od 6
Address:
City:
Zip Code: �7 ?i Lit) 3 Fax:
Phone No.
State:
6 9" f� i/3
E-Mail:0'ee- ep %G dL i�-6 ��t a&. .
Fill in fee simple Title Holder on next&.
page ( if different
from the Owner listed above)
E-Mail: of f Zy/ an' d
ilQ.l
ao' CcJK
State or County Licen : L C
6 9 to
If value construction' $0 500 or more, a RECORDED No Ice of
is required.
P. I JD.
ti
�P _ MENTAL"CONSTRUCTIO N LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name: 4R27'
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 5,ok
Address:
City: 6W : t7l State:
K Zip: ! c Phone: -
m
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _ of 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 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__---�
i11 O= ►�
_ Signature of Owner/ Lessee/Agent
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF �A�,PiP act,
The forgoing instrupp nt was acknowledged before me
this __q_ day of 20 & _by
onu/ . (nn-lir19e/lri�f�'
(Name of person ackn wledging )
r
(Signatur of No Public- t of Florida )
Personally Known L1_11� OR Produced Identification
Type of Identification Produced
The forgoing instrument was acknowledged before me
this —a day of -7, rn2 .20 1b by
OnmiS�lKl fY Irac411 1 e,&, Ar=i h2a?ow
(Name of person acknowledging)
Ajilfl—,A daaA—
( 'gnat re of Notary Publi - State of Florida )
Personally Known OR Produced Identification V/
Type of Identification Produced !�- t_ Lice-er.s
Commission No. MARY E RICHE LrFOmmi ton No.
• : - Notary Pu61ic -Stale 1 Florida
.� •. My Comm. ExoPes Ja 211 2nro
Revised 07/15/2014
163621,,
CHRISTINAMACMULLEN
MY COMMISSION Y FF 917501
Banded
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
p -0
COMPLETE
INITIALS