HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /0 Permit Number:
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WOUNNEENEENE001111100 ..Building P r DEC - 2 2216
'S%Anopplication
Planning and Development services
BY
Building and Code Regulation Division
St. LUde Countv _'9L Lucie C"', LY, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED-IMPRQVEMENT LOCAT10%
Address: s?lo 7-5- h"w, � , , 6110L P/ �,V
Legal Description: sie-L' / 'Im Ora : 6_41-97SA9,r 12224Q Idb: 'J 21A 9M;Aa I/
6F V U
Property Tax ID #: Lot No.
1.00
Site Plan Name:c4 A'Atd 'eIg a"411� Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
0 PtA-
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all apply:
1]HVAC ED Gas Tank UGas Piping Shutters
Windows/Doors
RrElectric 0 Plumbing OSprinklers DGenerator E]Roof Roof pitch
Total Sq. Ft of Construction: S Ft of First Floor:
Cost of Construction: 0. 9 00, 00 Utilitiescn Sewer [:—]Septic Building Height:
OWNER/LESSEE-
CONTRACTOR-.
Nam
Name:
Address:/e, 51
2 IIA42- 82
Cc )any: Y941;h Aj"JIA�t�
mp
City: W_ State,
Address:
i,ode: 1.,TA �2 Fax:
City:, P"n Statelz-A
P h o n e N o. 7'7,?, IM, 5 cil/ 7%
Zip Code: 'q'V945 Fax:
E-Mail:
PhoneNo. JV64,2191
Fill in fee simple Title Holder on next page I if different
E-Mail: Z4 ft& 6,20;119 - J2 b_e4(aad_ er .9m
State or County License: 6-dafq&:��5e
from the owner listed above)
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If value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
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—iliac Appiicaoie
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 Coun makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in MnWict 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 len�d�r an attorney before
commencing work or recorftg Your Notice of Commencement.
bignaiure FrrUWner/LesseeVyontractor as Agent tor Owner
Signat*)t ot Contracty/License Holder
STATE OF FLORIDA
COUNTY( _T tue4!re.'
STATE OF FLORIDA , r
COUNTY OF- 5�= 6,Llu e�
The for oing instru nt was pcknowledgeqpefore me
ths, by
The forg2ing instrunjent was acknowledged before me
319
20 LLP
this day of 20 J�, by
oyll-e_
��
6L
OLA�t &e_ �
(Name of person acknowledging)
(Name of person acknowledging)
C�J �_ Q/'�
`�) 6_�J 6Z all_��
(Signature of Notary Public- State of Florida I
(Signature of Notary Public- State of Florida I
Personally Known OR Produced Identification
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Personally Known Produced Identification
Type of Identification Produced
Type of Identiflcation Produced
uAviDIVINMON
Commission No. FFIV6_15� NOTARYPUBLI
D IPRtX
Commission No. DAVID RAYMoN[
STATE OF FLO
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IDA NOTARY PUBUC
OASTATEOFFLORI
ME19" Expires 1120/2019 Comn*FFi9w5
Revised 07/15/2014 Explres 1/26/20'
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS