HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n
Date: Permit Number: O O _
OCT 05 2011
Building Permit Application
Planning and Development Services PERMITTING
St.Lucie County,FL
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential it
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line ?
..„ ,s qhs�h.�wG �..ly.;;� Y W::; � +;,..v. s ,5-} K '`.: $ 1 x s 73f•,;rti�^ �'{!'.i .t:}$'c 'k.,"Ma 1 i r' `frN.K "„,.d
� t
i.5+i�;,M''n'�°a9,K,..i.
Address: 1(S-D3
Legal Description: 40 Lcz)tKe Pi&)e- S LD r Ya a
Property Tax ID#: 1.31oZ �'D� Dl v��- CCO- �— �}� ��eti=e ✓l.nn 4 y JJ Lot
t 5&1
� r -721-5611
Site Plan Name: l/ �l°fF-eL�T--��� f`__ _ - `', Block No.
dG
Project Name:
Setbacks Front Back: Right Side: Left Side:
2aN"t:T. *; ?.3; 48"n'C ck.Z.t�i'L",'y.K j,.r�sA-airz •1x,x+� $ f �:'";"%r"' ,3 ..4, ; -} �,� a -.,:...ik:^'3" '"L Y'a 's"`e"3eEyn1,.S 'Tri`l�`.T3 z,"r'S.i.A"'t` ,..•1gs'" ¢,r.4.4:'"nee
.:.'5,s
, � _ .max r st� .s-:-"5.a1:: :]!. ,•.lntkte3� r§t��,yro icy::�,�'y{:"�'�"ty5�a.£],a;?�^i''�� �4=14
C Et•4�V Ce CJ .. �QO�. /�d S l 2 L: i��4•
� �2r a-.t. .y �5•.r`a..ttf .*"tr.T",Ssx�"i�i�,s �.r r'" :�..roc?�J.N��I�.�•�' Jmvr^�y�., t�•, f :�n ���t}�� "*'t.?�.:�"'�� ]r�,.rs x .n.`A-��'"i:_t Z,�-.'Svc .a.w•1'FaX�.�l a$"r 73l'syL ��•,p.�:� ",:
` Al
;=q
Additionalwork to be performed under this permit-check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters 2' Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 0 Utilities Cn Sewer E]Septic Building Height:
.:K:� i�, .v, y, `..,-`;,. ,� �h:.�¢rX<� �{az't;,�s.�n:� n? T�:.:: '�'iS1a?'S^ '' a"g;qe••- ,F �s.:� s �A C -`"5.2 its ei`v r� - ? siK
-,tt 'wry' f �4 gsr«� �. 3 t ♦;< :;�71 r�ki.�'�. :.rr+ e ,:� �''$'„K_..,M�i F,yzs 'A,F,�iir•+K �'"-'�'^..
c
Name 1 "A )'I'S -
Address: ym03 Pa4LLC3 / i,vC'S Ci r Company-7—F-4-co
City: I f _ `Pl�✓'C`P, StateE� Address:
Zip Code: tf 9 s- I Fax: City: 1_.0 aDzj k Wi E'c-i Cjr,_ State:-F
Phone No.2'2a - 'R39- S-3Sta i Zip Code:3SLI I a-- Fax: 51_I . e -
E-Mail: Phone No. b/- SS !-1 os a
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: L G 0 0
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
�;r^kkP t>,syf5+,°:f fr rfwwy�'r �t N�°+f i ay"�z.,�
a }r C`.uY.. '� f�* �s�i � `�}}s?^w:a 3!'t-��'S•��ea?£r�'u. <,gq� .�'4 �r Yud
RIJC'�ON£UN ��MA7�IQIV: m
_Q01gra kf ,. i, s:x'trw^^'. 'Y�.�M.�#tt^,e
,..x.,.&i. .1.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: 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 thepermit 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 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
commencing work or recording our Notice of Commencement.
0_547D�� s
.,Signature-6f'Orwlie°�,. /L / gent esse nature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF iT �c >, o, s COUNTY OF �/U.� 2 r
The f r oing ins me t was acknowledged before me The eying oing instrumen was acknowledged before me
this j day of 20 Vaby this; day of 20 �.�by
Jarrwj Dom/
(Name of person acknowledging) (Name of person acknowledging)
`c ^"
(Signature-of-No'tary-Public-State of Florida) (Signature otary Putic_State of orida)
Personally KnownR Produced Identification Personally Known ✓OR Produced Identification
Type of Identification d Type of Identification Produced
HANIEPARE .. �` c; � �° ��rf4)�
Commission No.
Nofo � Commission No.
Ic--Stat W-
�I• �i flyOOPJJ9SSI N
Ffi_P7;E_8;/MY Comm EkPres ai23F2018 ; PXPIRFS ApTil 19,•! �Ia
����hnu�N�, `A•GF,>� Florldah'o4aeySenru�e,rom
Revised 07/15/20 �ndedlh►ouphAgtlatWl,NotaryAasn `���'
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS