HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: in Permit Number:
RECEIVED JUL 0 7 2017
- I SCANNED
Building Permit Application BY
Planning and Development Services St. Lucie County
Building and Code Regulation Division
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 line I
Address:
Legal Description:
Property Tax ID #: 611 Oc-�o 3 - ec90 - 0 Lot No.
Site Plan Name: Block No.
Project Name: 06-EAN R-156 (20 AlbOly1dill VIV ZftO' Cl� OJW
Setbacks Front Back: _ Right Side: Left Side:
1._0ETAi(Lc�,6E8C.RI1PTIOftOF WORK:
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fi-L Utz; t;-
/0� / 261, 3cer �-o 4 _5D 9-0 //0
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tONST UCTION INFORMATION: -
Additional worK to De-performeci.,
11HVAC
Li
under IFIS �iirffilt ::"cqcR a 11
Gas Das Pii
apply:
Shutters
Windows/Doors
Ta4""
ON
Electric
i'g []Sprinklers
qm, b n
ElGenerator
1:1 Roof Roof pitch
Total Sq. Ft of Constructio
Cost of Construction: $ &Dfr)
S Ft of First Floor:
Utilities'll Sewer []Septic
Building Height:
WNER/LES�EE:
CONTRACTOR:
Name iz.. ec ftij di�,
Name:
Company: iDWCFcS*e1- C5�TIE97 -
Address: fZ21BL�;L- _sF_1y0A1P-'C%6_r !;�-T
Address. A) -7)L :2f 911�61J_
City: C,o Sce-7 State: jQ,,
ZipCodeY ?21494-4- Fax:
Phone No
n�-T State:
City: !�' —
Zip Code: ��49!�z 9z: Fax-.W2 — 7- 0
� T(S 1 2-
Phone No. I
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: J7?"C044c, C-W"Z'. 66M
State or County License: r-6L t-- 's-z- 0,0 6 '2—
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: III
MORTGAGE COMPANY: X Not Applicable
Name: ML4� Ir . ame:
Address: --7,b �J_J 5;MvF_ AkAw �)wy Address:
City: !�M/949=�F State: L_ City: State:
Zip: Zip: Phone:
_?J _�Phone:2-??_
FEE SIMPLE TITLEHOLDER: ,�Not Applicable BONDING COMPANY: Not Applicable
Name: 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 makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in cc 171ict with any applicable Home Owners Association rules, bylaws or and covenants that m estrict or pro hibit such
Ic
ayhi
structure. Please consult with your Home Owners Association and review your deed for any restrictions w h 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
S
Signature of Own�esse o r tor as Agent for Owner Signature of C or Li r
STATE OF FLORIDA STATE OF I'MV)
COUNTYOF '6�J-QC-0, COUNTY OF- , - L'Or-1-C,
The for oing instrument s acknowledged before me The forgoing instrument was acknowledged before me
thi- 4 day of "TZ G , 20 1 this -2j— day of -5 %� ). !J 201J_ by
(Name of person acknowledging) (Name of person acknowledging I
(Signature of Notary PublkL State of Florida (Signature of Notary Pbblic-State of Florida
Personally Known Personally Kno14 . fted Ue
Type of Identificatio Type of Identifi itipf.�,O
q ��uce
COMMISSION 4
Commission N "IRES: Memn�
Commissiol
...... � Bonded Thra Notary Put
Revised 07/15/2014
REVIEWS
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ZONING
SUPERVISOR
PLANS
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MANGROVE
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DATE
71
COMPLETE
INITIALS