HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APP/LIICA�B7LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �j 9
Date: /.'G�'� SI;HNNED Permit Number:0��
M BY RECEIVE®
St. Lucie County
Building Permit Application FEB 2 8 2017
Planning and Development Services
PERMITTING
Building and Code Regulation Division
5t. Lucie County, 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 III
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Address: RbrD �✓ t7�El4N �/21 ✓E ��
Legal Description: -r H-C f?4itvciE�5 oG flvTGl f ijv5oN S�YN✓� Utv tT IZy �
(0VZ 12,(oq- 2Zoo' 3158:3y,F-z-1C3
Property Tax ID#: 1-frb2 - (010 - nil S- —MO-5 Lot No.
Site Plan Name: P64An Block No.
Project Name: l�✓LI (a-0
Setbacks Front N 4_ Back: _4!� Right Side: 401_ Left Side:
)00 a
pi�L /a CSI�LETJf 7 O (iG-TII A/Ios QAf�}^j—
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AaaltlonalworKtOoe errormea uncierinis permit —CneCK all
❑HVP ❑Gas Piping
apply:
Shutters
Windows/Doors
Gas Tank
_
❑ Electric
❑ Plumbing ❑Sprinklers
❑ Generator
_ Roof ❑ Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
El
Cost of Construction:
$ �i 000 Utilities:n
Sewer SepticBuilding
Height:
OWNER/LESSEE: ;, m
n •.�
CONTRACTOR
... ..- 6
Name P:aILSO. (p-NfIfDARA
REL-w
Name:
Address: q(PT0 S OQ9Prr
'DZ # 1205-
Company:
City: TGjg.&Xj 13l.'A�
Zip Code: ?yN`IS1 Fax:
Phone No. o` o'i� - %o03i
State: FL
Address: aziG A. L
City: l I lFh2-T
Zip Code: ?N99 i4
Phone No. 772
Stater
Fax: I:,q 2 97LP/
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: iM I CI (-#�Ltl.
r�aZiN11Al�C(A l�oo soh
State or County License:
If value of construction is $Z500 or more, a RECORDED Notice or Lammencement is requirea.
t
a,: s _T .:
DESIGNER/ENGINEER: _
Name: t?uAleohgr Af1111N"'"A
Not Applicable
A11AIN
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
I343d
yCFjal
Address:
City:
Zip: ?L 7 cp Phone: z-L
State: r/
532 o
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 yy 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 f ' ur to Record a Notice of Commencement may result in your paying twice for
improvemen o your,g�pprope y. Notice of Commencement must be rec rd posted on the jobsite
before the rs ine�tion. intend to obtain financing, cgr�sult wit e can attorney before
rnmmpn .me o dff r vour Notice of CommencemOnt/ O
Signature
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF,G.7— _/ /JCIF_ COUNTY OF T' Z/N'/"a-
The forgoi,{1g instrume t was acknowledged before me The forgoin instrument was acknowledged before me
thi�' Wy of �,�+� . 20/zby this�P_L of ,,d5;6 , 20 (Z by
(Name of person acknowledging) (Name of person acknowledging )
(Signat�tary PuState of Florida) (Signatu otary Pub i =State o F orida )
Personally Known .,� OR Produced Identification
Type of Identification Produced
Commission No.
MY COMMISSION S FF 173907
Revised 07/15/20
Personally Known FOR Produced Identification
Type of Identification Produced
Commission No.
ANN M. GAUAIOND
2018
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETE
INITIALS