HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO
--//MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,2 ' 21 SCANNED Permit Number: 1
St. Luce County RECiz:ntfED
Building Permit Application FEB 2 8 2017
Planning and Development Services PERMITTING
Building and Code Regulation Division St. 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
PROPOSED"IMPROVE MENTLO.CATION 11 ' °.; �4
Address: q&05-o�7 S' t�LEM.I Wz. 4b5-
Legal Description: -rfh; iVr2(NGESS Or, r'r�K7rr forJ SSLAi✓p WVI
LO r2. 3Z01 -G6Z)
Property Tax ID#: giro?-(Ol0-6o3i'_n00-(�
Site Plan Name: AI LAJOi+�
Project Name: i✓ t�0
Setbacks Front Back: :% Right Side: Q Left Side: N
Lot No.
Block No.
DETAILED b0CRIPTION'0 ORK '
�o vt_ I�—�1�LitnEN r i yo Pr�vin/bs - Twlpgr�-
s(.I D MI!, GLA-0 Too✓LS
CONSTRUCTION INFORMATION;.
itiona wor to e e orme under tispermit-c ec a apply:
OHVAC E] Gas Tank ❑Gas Piping _ Shutters Windows/Doors
0 Electric 0 Plumbing Sprinklers 0 Generator Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 121 Clad
S Ft. of First Floor: _
Utilities: Sewer 0 Septic
Building Height:
OWNER/LESSEE m. ,"
CONTRACTOR
Name
Name: lylllirmm�7
/
Address
Company: �E�L4Dt/ G�f��4
41U/Ll/hIl(d/1
City: Stater
Zip Code: 301:>3 Fax:
Phone No. 4141) 1467- 1i4u
Address: 91-0
City:
Zip Code: 3L194H
Phone No. -7Z' Al
Stater
Fax: %; 91 -9-741
2 - 009r U
E-Mail: TA✓LAfOL-O 0W 1 r 2 2, Cora
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: Al f c-H-A-GZ L.
GOOOWLY yR bt Or
State or County License: _C(,r
u:6 n y,q;-
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SU�?Pl♦ MEN7ALC�N5fRUJOI�MLINWtNFQit>t1ATItiN
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DESIGNER/ENGINEER:
Name: n/ r /UMlAlm
_ Not Applicable
OI/Glase&A
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address: / to3 S0r1? 9r41gacrAgWff
Sdrn la)
Address:
City:
Zip: '2�7�,0 Phone: Z
State: J�_
S 2 -
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 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 Assocation rules, bylaws or ano 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 fa' ure cord a Notice of Commencement m sult i paying twice for
improvements to your prop y. Ice of Commencement must be r dad a d osted on the jobsite
before the fjrsf jnsp ion y i end fb obtain financing, consult w' ende r n attorney before
comment' ja w r r re rdi ur ci ice of Commencement.
s
Sign a of wner/Lessee/Cont cto as Agent for Owner ' nature Contractor/L ense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF _S'T I ACJF COUNTY OF b'T �L2CfE
The forg i g instrume M was acknowledged before me The forgoing instrument was acknowledged before me
thi 2 yof . 20/Zby this of 4�A 2017 by
(Name of person acknowledging) (Name of person acknowledging )
(Signatu f-Notary Public -State of FTorida) (Signatur Lary Public --Irate da )
Personally Known J OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.
ANN M. GAUMOND
Revised 07/15/2014
Commission No.
ANN M.
EXPIRES: December 7, 2018
Banded Thm Notary Pubrc UndeAvftm
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