HomeMy WebLinkAboutBuilding Permit Application Sep 23 2015 15:14:35 Via Fax -> Vanage Page 002 Of 004
ALL APPLICABLE INFO MUST BE CO11 PLETED. ORAPPLICATIC9N-T.0'B9:ACCEPTE1D: F'.:' '
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Date:
Pe"ririiti:lurtitbr: Q
Building Po itAp licaloll .
Planning and DevelopmentServtces
Building and Code Regulation Division
2300 Virginia Avenin Fort Fierce FL 34982
Phone:(772)X662-1553 Fax:(772)462-1578 Coln mercial � Residential ..br `_
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address-
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gal Descriptionw- C.. t��c �" •, -;:; �MT' •i1�. � , � +.
Property Tax ID cr - te5 W � '� a Lot No,
Site Plan Name:. ..m _�.,,,.•mm� m ..,.,.,..m....���.".,�m� Bek No. f
Project Name:
Setbacks Front Back: ........._..............._ Right Side: Left Side:'®
f 'I A . '..e21�, _�yx �•,!'fJ2 1 } P het
dditicina..wor :. e ertoeitied under this permit.—check a •app y:
Gas Tank Gas Piping _ . haulers L1 Windows/Doors
: Flecfric'" Plumbing �5prirlkler 0:6.6her�aCi7r Roof
°:Tea1.fal Sq:'.Ft of Coristr'riCtio,n: S Ft;tiff First Flbi r: -- _--
C�S't tiF:Cc�ri'strtEetrori:$ _+ Uti�itie^5: . :,Swr;Ll'5eptic Building Height:
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Name 6t fame
Address: w`?fit fp e i... C,,-,A 4=`lc,c Company:s , � t>F�c hc<dh
City: PC"" 4 State:EL address:
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Code: '��L�, Fa.x City: S'ta'te: ' Q.
Phone No. Zip Code: fax
-Mall: i Phone No. �? :t '-• F7•7 __..._
Fill in fee simple Title Holder on next page(if different , E-Mail.: 6l t�c,��a•fr�Cx�:�'�� aoz i.c°�fwt
from the owner listed above) State or County License: C
if value of construction is$2500 or more,a RFCORQED Notice of Commencement Is required.
Sep 23 2015 15:15:24 Via Fax -> Vonage Page 003 Of 004
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QESI IVER IVhIGiNEER: u~"niot Applicable MORTGAGE COMPANY: tdot Applicable
Name: Name:
Address: m,.W.w Address: -- ---
City: ..........................w,.,,,,,.,.,»,.,..,.. .—State:—... City:
zip. Phone: Zip:. Phone:
FEE SIMPLE TITLLDER: Not Applicable BONDING COMPANY: Applicable
Name: _ �u•,° Name „
Address: Address:
City: , .. ,._._ City:_........
Zip' _Phone: _ Zip: ,.. m.,..Phone:
certify that no work or installation has commenced prior to the issuan6 df
St, Lucie County rriakes no representation that Is granting a permit will authorize'the:p&6it•holderto build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or an covenants that may restrict or prohibit such
structure.Please consult with your I Lorne Owners Association and review your deed for any restritiions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all raspects,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 pasted on the jobsite
before the first inspection_ If you intend to obtain financing, consult with lender.or an attorney before
commencing work or recordin r Notice of Commencement::
f ignature of Owner/Lessee/ gent Sign . o Contract +cense Holder
STATE OF FLORI . U-
STATE OF FLORIDA
�
COUNTY OF... i, LG„A e COUNTY 01 t, f .
The forgoing.instruViertt was acknowledged'.before me The for t"ing•in's ment.was acknowledged.before`rrie.
day of �a Zl1 � J�y" ;€11'iSdy:t?f' v ' �M-,;,f0' 911119i1ii91�1����. ,
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,,.- _ MLaa6{�$1Bk46ii0idBls � &1 A ir•. �''�8®� ,.
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:� �'• e"'ti\k` V�orma$ea°ow°I °�,p� ". w
(Name of person icknowled ing} b m
of person acknuwlr?dging} ;
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{« t },.•. X91' 4 �o-e �n F /7w °% #FF 1955337 ®rte
t;?'oK.. •: w'�•. OF 195337e� ...,�,.�•.` '�',S°� ah'% "' 'Sr ra r°
(Signature of Notary Public-State of-Florida) afore f P I t.(a rids m'�ti°"°•*•••'® q>'"a�'
ala N • vera•°a f"� 11M CIC
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N.,,rsonall Known . OR Produced Identifir ti �' taxa er50,0y:.Knawn " ...r 037.'Produced:ldertfif'scatian.: ',' ::
Type of Identification Produr,Pdm�,,,• .� _ '•'Type•of 1-diii'tlfitifi6f"1�r(�tiEii`i�tt
Commission No. rT I ",. (seal) Commission No, F q 3' (Seal)
Revised.07/15/2014
REVIEWS FRONT ZONING SIaPERVi5011 PLANS: VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW • REVIEW " REVIEW
COMPLETE