HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLEty FOR APPLICATION TO BE ACCEPTED
Date: ,?- 7 - / 7
Perrnit-Number:
M RECER.:D AUG 0 01017
SCANNED
BY
Building Permit Application St. Lucie County
Planning and Development5ervices
Building and Code Regulation Division
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
0
PR®P FD IMP„ROUEMEN1T LOCATION:
Address: q$O( S. Ocean pp_ JcanSe.-\ JReac_k1 'FL .3y9J 7
Legal Description:
Property Tax ID#: q Off- 5d) - zo0o- 600lin Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
t� s i- If or\e s]1a �Z sa; I �anop Cad` k ate'
0 Plumbing
Block No.
❑ Windows/Doors
0 Roof
Total Sq. Ft of Construction: 5--!!6 a S Ft. of First Floor: `
Cost of Construction: $ la�o tln.— Utilities:Sewer 0 Septic Building Height: / 0
WNE�R
AEONR:
Name f, f C5 IS c,
Name: The v J-or-e.
W I�.M
Address: S. e)ce_m,n 177--
Company: 12m,
City: 3 4-rr1 d e, h Rc & e. k State: F_J,.
Zip Code: ,7!4 -4)% Fax:
Phone No. 77;2 -j - %T t3
Address: lea r -S. y 0 tl\ G a r-lL
City: rf� Pi !z _
Zip Code: .3Y 9 y 7
Phone No. 77,;t- .5t
State:�G
Fax:
Z! to
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: Mlagoll
o➢hG=-AJET
State or Coun icense: G 6
G I �F 0
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SU LEMENIN: CONSTRUC it -N LAW INFORMATION:
DESIGNER ENGINEER: _ Not Applicable
Name: Ij v3 a
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 9,n e, 52e .) ,a ✓e
Address:
City: r+. F'i c rr�.. Stater_
Zip: sy 9.ra Phone: 77;;z - N6-o - 77
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 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 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 failure to Record a Notice of Commencement may resultin 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
commencing work or recording your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDI �p
COUNTY OF
The f r oing fnstr ent was acknowledged before me
this n/ -day of_�� 20 11 by
1/I hod Ohl . UU� . ra'�
(Name of person acknowledging)
Type of
MY COMMISSION 0 FF923607
EXPIRES octo(6eal) 2ot9
Revised 07/15/2014
to CD o _.._.i S
Signature of Contractor/License Holder
STATE OF FLORID
COUNTYOFT� itlrc Q
The forgoing instru nt was acknowledged before me
this oMday of -, 20 _L�_ by
(Name of person acknowledging)
(Signature NotaryjPc-!State of FloridaPersonally Known Produced Identification
Type of Identin COmmIS510n NO. Y COMMIS 0 F''FF,,923607 _
E$�y 2019;
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
RfVi
REVI
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS