HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUSTff BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �_IQI11 Permit Number: I"1 �q-(3;acoo
RECEIVED SEP 2 0 2017
mommommonono Building Permit Application SCANNED
Planning and Development Services BY
Building and Code Regulation Division St. Lucie County
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 W „Aadtos
PROPOSED IMPROVEMENT LOCATION: 1
Address: Qb(n 5. ncienn D r. n I Legal Description: F-Woress Cnndn I ut- m tin IIllM
(o
Property Tax ID #: y--5,O1 _ _ (0Zo - (�% R ' -= - L-1Lot No.
Site Plan Name: _Pn r7 ( 1' �Rrsic �'Imc e- Block No.
Project Name: _ Mnto
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
+Remove and replace SI i d ► ng GI ass Dc o S
1 . I - _.
CONSTRUCTION INFORMATION:
itiona wor to e e orme under tispermit-check all apply:
❑HVAC GasTank []Gas Piping In _Shutters Windows/Doors
❑ Electric ❑ Plumbing []Sprinklers❑ Generator ❑ Roof ❑ Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ i� ' OO Utilities:CSewer ❑Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name MOc
-
Name:
Address: n
Company--Mc-, I
City: ,'j `(state: FL
Zip Code �4ta5_ . ¢ax• 6 16
Phone No.
Address:
City: �Sif_Li � `dam X ' i %. State: FL_
�, -7 _ Selo -0410
Zip Code:-, ,r Fax:"
Phone No. Z - ' LI q
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: pcD2 1 I.t-s eCl I n �,,4 n roqQ9 rim
State or County License: I q iD J
it value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
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 holc! 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.ybur 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 yo paying twice for
improvements to your property. A Notice of Commencement must be recorded and is ed on the jobsite
before the first inspection. If youllkIlend to obtain financing, consult with lender or torney before
coaTrffeT cingywerk nr recordi r Notice of Commence Et. \ ,
as
STATE OF FLORIDA A/) ��
COUNTY OF '' a
STATE OF FLORIDApA n'/ �i
COUNTY OF �J a
The forgoing instrument was acknowledged before me The forgoing instrument was iicknowledged before me
thisWIdayof 20 17 by this day of HUCY; 20 I'% by
ruu1d 1Liaprodee `-mold 16-N cle
(Name of person acknowledging ) (Name of person acknowledging)
(Signature of NgJary Public- State of Florida )
Personally Known `r OR Produced Identification
Type of Identification Produced
Commission
Revised
:�:►Y/lXtdfi
COMPLETE
INITIALS
COMMIBeIOR # FF 920266
My Comm. EKplroo Oct go, g016
A1JQU.N- 7,JiCQkM&�
(Signature o 91otary Pub' - State of Florida
wn 7O)
Personally KnoR Produced Identification
Type of Identification Produced
Commission
FRONT ZONING SUPERVISOR I PLANS
:OUNTER I REVIEW I REVIEW REVIEW
KELLY W
dart' Public • Bat to of Florida
Commission # FF 929255
Bondedthrough
VEGETATION ISEATURTLE ,MANGROVE
REVIEW I REVIEW I REVIEW