HomeMy WebLinkAboutBUILDING PERMIT APPLICATION2
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: in- 1,2.17 SCANNED Permit Number:
��' M=q�
BY
St. Lucie County RECEIVED
Building Permit Application
Planning and Development Services OCTI 2017
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
i R 'E E' 'ibit,'An 0�"
OV M q 6
Address:
Legal Description: 6&Ad1011CLrV1f1Q-, &Adomlw�t 0 — tLin- &_ to 19-
Property Tax ID #: 36 a 07; (0 0 4 - 003 1 - oo 0 - I- Lot No.4"6�c
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: _ Right Side: LeftSide:
I< -_ /
-3 To Te
CONSTRUCTION;INFORMATION:,-,
AaaitionatworKtoDenertormed under this permit- check all a_p_pTy_.�
OHVAC Gas Tank E]Gas Piping Shutters Windows/Doors
11 Electric Plumbing []Sprinklers Generator Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ /"
S Ft of First Floor:
Utilities,cin Sewer OSeptic
Building Height:
CONTRACTO
�arne Vdi.haaf
koLPROL
Name:
Address:. 44q36 150901IS'A Odk
&Lft
Company:&7'09We.-_-'-0A/
Ad d ress 16mss_ 5- /CVIV 72t _72F<� '41C7.z7;11
City: MOSO Ni U
ZipCode: i4Soqo Fax:
] -10
PhoneNo. (613 -7 - an I
State: 0 14
City: '7-Zv41 State:
Zip Code:93 4/8 Fax:
Phone No. -///0
E-Mail:-
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: A/2)D a --z- , exvn
State or County License: e&el C5-C?3 9-/
It value at construction is SZ500 or more, a RECORDED Notice of Commencement is required.
;i,
IS PLEMI�Nj���.-CONST-kt)C-TION�LitNiLAW,-..iN'�,6RM�,Tlb f " - I I
W
DESIGN ERIENGI NEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
Zip: _ Phone:
BONDING COMPANY:
Name:
Address:
Zip: Phone:
— Not Applicable
—Not Applicable
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 conIct with any applicable Home Owners Association rules, bylaws or anscovenants 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 Reccir� 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
commencina work-erT-ec-o-r-diNg vour Notice of Commp.nrpmpnt-
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The foyp"struM
'$ Th f instrument was acknowledged before me
,y�pcknowleclged b
_gore me
this C3 day ol 00— 1 20 L?6y th, of 20 _/ 7by
I u cmyd cu� 14�-Cholrrl cAgovywo
(Name of person acknowledging ) (Name of person acknowledging)
I& b.'AA A "Do* -
(Signature of Notary Public- State of Florida I (Signature of Notary Public- State of Florida
Personally Known V OR Produced Identification Personally Known —/— OR Produced Identification
Type of Identification Produced— Type of Identification Produced
Commission No. (Spall -r— mission No. (Sea[)
MELISA ARMENTO
w� '.
F01 � I IF-,- .6 �. mrusA Agmr To
MY COMMISSION# GG 058886
M ......
EXPIRES: Decemberii�C2W
Revised 07/15/2014 1 .
S=W7uUN0tMPUbk4 EXPIRES: December 28.2020
..... . W40d 71w No" Pubic UnikiwHeis
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETE
INITIALS