HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: laglaDuo RECEI'.' DEC 13 2016 Permit Number: '3a�4 I
01109
Building Permit Application 6GANNED
Planning and Development Services SY
Building and Code Regulation Division St- LUCie Cowtv
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
I
PERMIT APPLICATION FOR: To Select from dropbox, click'arrow at the end of [in e
PROPOSED IMPROVEMENT LOCATION: 6 " 4 1 'NIT OF N L' OFTSOE P1104 AND �E R/W ANGLE RD RUN
Y W _7 FT 'TH
SEL SO RJV 760.55 F7 TO POB, TH NELY AT RT ANG TO SD L
Address: R/W 300 FT, TH SELY // TO NELY R/W ANGLE RD 252.2 FT, TH
SWLY AT RT ANG TOLAST DESC COURSE 130 FT TO PT, THRUN
NWLY // TO NELY R/W ANGLE RD62.5 FT TO PT, TH RUN SWLY ATI
Legal Description: RT ANG TO LAST DESC COURSE 170 FT TO PT ON NELY RM
I ANGLE RD, TH RUN NWLY ALG R/W 190 FT TO POB (1.50'AC) (OR F
Property Tax ID #:Lqo�Q ok�' 5—o o4i�) Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: _ Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
I CONSTRUCTION INFORMATION: III
PkUU I LIU[ Id I WUJK LU UMI I UJ I I ICU UIIUCI LIM JJCJJ I I I L-WIZ�K 01J [nOpply-
E] Gas Tank E]Gas Piping Shutters E]Windows/Doors
11 Electric Plumbing []Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: - &-� I S, Ft of First Floor:
Cost of Construction: $ 1000, 00 Utllitles:t Sewer OSeptic Building Height:
OWNERAESSEE:
CONTRACTOR:
Nameht�q\t Vx)()J
r-a e, L kl�'
Name:T)Ojnle,�_ inFWrNMCe_
Add ess: ��-32 '5 E_ cez� E KN �1
City: 5�-A qw �gtate:
Zip Code. qq L1 Fax:
Phone NI( q3-a) (9- 1 'SLV Lq,;—,l
E-Mail:
company:rANIW
Per-cf,
Address-.293bg SE_cTe_��O�)
S4-a
City: C'+"0�4-
Zip Code: ?>H q q��
Phone No(-�142_) 7-
State:
- _E�-
Fax: -11 a- -k4l,- QSC- 5
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Fill in fee simple'ritle Holder on next page (if different
from the Owner listed above)
E-Mail: *r�' i+S&A
flor-Ilei,se-ence',6cr-1
State or County License:
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGI NEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: _ Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: —NotApplicable
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 Coun,4 makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in co 1 lict with any applicable Home Owners Association rules, bylaws or and covenants that ma estrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions yhich may apply.
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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 fi ancing, consult with lender or an attorney befor
commencine wz&-�clinv-mour Notice of Cormencement. /1
as
STATE OF FLORIDA - STATE OF FLORIDA
COUNTY OF kZ2):;� LL&&t Do LA�
COUNTY OF—.54-i
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1pl�Aay of UCP,-Y1,La Q_/-_ 2o b4by thik-ti) day of D! �Ifr 20 L�a_ by
A-gry,
(Name of person acknowledging ) (Name of person acknowledging
(Signature of Nota"iublic— te of Florida
Persona.., 75�0R:Produced Identification
Type of Identification Produced
Commission
Revised 07/15/2014
&GA96y samsd
NOTARYPUBUC
Comm# 0GO49730
Expires 111/2212020
(Signature of Notar:�F�ubliatdVbf Florida
Personally Know.. OR Produced Identification
Type of Identification Produced
Courtney Samsel
Commission No.Giecql�lo NOTARY PUBLIC
AVISTATEOFFLORI
Expires 11
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