HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR A#PLICATION TO BE ACCEPTED � r
Date: 4. 2W 'U. SCANNED Permit Number: / /1 &9 Y'/
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BY
St. Lucie Countv
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Application RECEIVED
APR 2 5 2017
Commercial
PERMIT APPLICATION FOR: 9" t)
Residential
Address: `,R�c n It a,\"U � C, , rel F'A {P, e-rc.i F) 3 ic4 g
Legal Description:
Property Tax ID #: Z as. 5 OOO ob
Site Plan Name: S rJ N p _%
Project Name:
Setbacks Front Back: Right Side: Left Side: GI
Lot No.
.. M
A-5 WLL C j h ee,A, e%e7cfi.-FL %y Uf�Ii f I % l 0V4 os-j X o4,
_Mechanical _ Gas Tank - _ Gas Piping _Shutters —Windows/Doors
_Electric _Plumbing _Sprinklers _Generator
Total SgsFt of,Construction: Sq. Ft. of First Floor:
t. .0 nstr0Z46 d0OQ�." Utilities: Sewer Se
CosY.of.ConstcUct�on;-$ % _ Septic
Roof
Building Height:
Pitch
O NER/LESSEE:
CON�TRA'C«P(}R:
`Name 1��b ✓!%s�'L _
�; > h-r _
.Address:'J• .�'1-o QLe
,Name ' �LG ` C(y� �e� FOIn/
Company:��� >, r'<WUc
r'
State: l 1 .
Zip Code:' Xaq& D Fax:
Phone No. 7a S-Cs�J- --3
Address: I (L4yl� OttLic_
c%xi 0 -3
-_
City: IeCa t3 ). Stater{
Zip Code: SM 6O Fax:
Phone No -i7A S 3$- DkfQ �
E-Mail: PoLt5j e- C eU.-oft ✓/'IewL( , CQ!�^
Fill in fee simple Title Holder on next page ( if different'
from the Owner listed above)
E-Mail HJ c�cl� oo
State or County License e G C 0 6 o2
If value of construction is 2S00 or more, a RECORDED Notice of Commencement is required.
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made'to obtain a permit to do the work and installation as indicated.
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 & 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 lender or an attorney before
commen ' kWork'ol'recordin our Notice of Commencement.
AxT-L
Rev.
S�UP�P�L NI rAL COIVSi"RUCTION
LI. W INFIRM`.
TIO
DESIGNER/ENGINEER: `• —
Name:
Not Applicable
MORTGAGE COMPANY: �
Name:
•'
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Sig atu e o Owner/ Lessee/Contractor as Agent for Owner
of Contractor/License Holder
,Signature
NC
STAT LORIDA ��,,jf�������
`
�-�,1,�,�
STATE OFfEBRf�A
COU OF I1�(/AA.Wyt
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COUNTY OF YVQ,1/\I 13V`C�+'
The g instr a as
this ay of �
acknowledge-�efore me
20LI by
The f r mg instru�ent w�a acknowledged before me
this by
�CTT��S
.
of /�'(��'^20�/,%
I ^ay
(ia{TTl r\l
N (UW I
(Name of per n acknowl gin )
(Name of person acknowledging)
LCIV
YJI/�N IDLY`-' ` r J ..+ti++a.1toi..
( ig re of Notary P ic'
tote of Florida)
`(Signs ure of Nota ublic-State o�
�
Pers Known
;�����\\��8,
,
Personally Known � OR '•?'
ally .���
ro uce
`4'�•'0':
Produce�ldeiitific�i�p .
Type of Identification
JOLENE K. SOUTHWICK
Type of Identification
Produced
MY COMMISSION #FF079740.
Produced'
r ''f'„"'rid;•+'EXPIRES
COmmissiOn NO. 3
Deoamber 29, 2017-
Flo S@�
Commission No.•'a�VBI.
aryService.corn