HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST, BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: )i. I ro
Permit'Number:
RECEIVH NOV 10 2016
Building Permit Application SGAN[ViEL)
Planning and Development Services BY
Building and Code Regulation Division Cie Comb
2300 Virginia Avenue, Fort Pierce FL34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
1. PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line S'Neth III
I PROPOSED IMPROVEMENT LOCATIO N
Address: 5X
—, 47 S 0-0tJ e_
Legal Description:
Property Tax ID.#: 3 evzo 2 1 z a) toe) 3 Lot.No.
Site Plan Name: Block No.
-Project Name: 4"14,0 A-T_ � 15,911'.2
Setbacks Front Back: _ Right Side: Left Side:
I DETAILED DESCRIPTION OF WORK: III
Wdq11
t Z-C T_ 12 ( (-
[CONSTRUCTION INFORMATION:
Additional worKto De performed under this permit -check all apply:
11HVAC LJ Gas� Tank :E]Gas Piping InShutters Windows/Doors.
Electric. El Plumbing []Sprinklers OGenerator .[].Roof ='-,Roof pitch
/e
'Total Sq. Ft of Construction: S Ft. of First Floor:
'q. It
Cost,of Construction: $ no. r, .9 utilities-1] Sewer 0 Septic Building Height:.
CWNERAESSEE:
CONTRACTOR:
Name goeie tsi:3 r /0, L0.4 e -e
Name: 0�".,*,Opy , r-) 6../ _r
Address:- a -fop
Company:
-City: Z,�4&0!!s Stat%�Q
Zip Code: Fax:-- - -
Phone No.
-Address: 90V-C .4 4 7W _V i—
City: Rz oed State:2527
Zip Code: -7-7 WO Fax�
Phone No; XX RVA AV 2- OV 7
E-Mail: a2M4 �f P A41,eA?
F7Mall:
Fill in fee.simplie Title Holder on.next page I if different
from the:Owner listed above)
State or County License: dp,00_0 -Ova
If value of construction Is $2500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN ER/ENGI NEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: —State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _NotApplicable
Name:
BONDING COMPANY: Not Applicable
Name:
Acldre�s:
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 mayresult 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 your Notice of Commencement. I
STATE OF FLORIDA STATE OF FLORIDA -
COUNTY OF Fatt,, &x;Lc/_, COUNTYOF_ OW,� G(Qd_46,i
The cling instrument was acknowledged before me The forgoing instrument was acknowledged before me
this fu day of ^t6<A4,ct_ 20 fl�7_by � this_�:Lclayof �J&X�,C 20 (_GL_ by
(Name of person acknowledging) (Name of peirson acknowledging)
,:,- � , e �'-- , , 44�xz � eei��e�
(Signature of Notary Public- State of Florida (Signaturrof No5ary Public -.State of Florida
PersonallyKnown >--'� OR Produced Identification Personally Known �� OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission
Revised-07/
DANIELLE
commission #FF995383
-M.T.oniii Exiiiies May 23,2020
.. 1.11 ah National Notary Assn.
Commission
Notary Public - State of Florida
My, Comm. Expires May 23, 2020
Bonded through Nalkinal Notary Assn.
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