HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number: 0 - Oc'4&_
BY
St. Lucie County RECENED
Building Permit Application I
Planning and Development Services OCT 12 2017
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residentidit Lu�;
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
I PROFQ5ED.'JlMPKPVEMEN LQI�ATION: %
Address:
Legal Description:
0
I I r
Property Tax ID #: 3SAl - (Dog- oogg- not) Lot No906--D
Site Plan Name: Block No.
Project Name:
Setbacks Front— Back: Right Side: Left Side:
xmaou,) Roiflacuno'nt
'-/ 7-6-r--- I
CONSTRUCTION, I MATI
6N
AC[OitionaiworKtoEe-o-)e-ffo—rrmed under tfiis check all that apply,
11HVAC 1:1 Gas Tank E]Gas Piping liShutte'rs 126ndows/Doors
11 Electric El Plumbing Sprinklers D Generator E]Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ C�) Utilities"n Sewer OSeptic Building Height:
OWNtR/LES'SEE_f,-
'CONTRACTOR:-.-
Name rort�Sfouu-r. Mdan ota-1
Name:
Address: q C10 W tg-rA 'St
tt. . Z F
Company:C7WyAf,_--'-'v/"/
city: NQWYorK
ZipCocle: 10033 Fax:
jqS(
Phone No IER5 �1.1 6 0
State: A*
Address:/4��,95_ 10&71-1
City: "My' I 7_2�54_� State:
Zip Code:93 4746 Fax:
Phone No. 5-&/ -
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: eoa-1
I State or County License: 67,6a 65-q3 5-/
I if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
-SUPPLEMENTAL
.; 'I,
CONSTRUCTIONIIEN LAWINk ''MAT -lb''
�. � , , -, t ., - OP N'
7" 1 '_ . I I . I 11'� � , - .1 %
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
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 Count makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conWict with any applicable Home Owners Association rules, bylaws or an9covenants 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
as
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTYOF
The fojERWhstrut�V The forz ' ' strument was acknowledged before me
,,aareowledged b1ne me -gw
4 v 7
this L_-1 day of. 2 _ y this —S day of 20 b
y
-12'�C.Ywrd cyuniton 12zwy-d Oayftn
(Name of person acknowledging) Narne of person acknowledging )
'SA . A .
A himpy-r-
(Signature of Notary Pub State of Florida )
PersonE - 7CR Produced Identification
Type of cientification —Produced-
Commission No.
Revised 07/ 1 S/2014
(Seal)
(Signature of Notary Pub c- State of Florida I
Personally Kno.... 7 OR Produced Identification
Type of Identification Produced
Commission No.
MYCOMMISSION N GG 056886
EXPIRES: December 28,2020
Bv4ed Thru Now Pubic UrdeNaitm
(Seal)
MY COMMISSION # GG 056886
EXPIRES: December 28,2020
SixWed Thru Notaiv Public IJW&wftm
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETE
44-17
INITIALS