HomeMy WebLinkAboutBuilding Permit Application 12/03/2015 15:36 FAX IM001/003
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12 1 3 ! 20(57 Permit Number:J b
; .' RECEIVED
Building Permit Application DEC 0 3 2015
Planning and Development Services PERCJiITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential —k---
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: Z32- Mar` LO+11
Legal Description: �rz9p1 'W-e- pf Z.?ii'6 2.1(63) U,,,i L-03 Cor Z12R- l2gL
Property Tax ID#: 3410 508 02-LQ 000 cl Lot No.__3
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Artlonal work to be Derformed under this permit—check all apply:
HVAC Gas Tank
—]Gas Piping Shutters Windows/Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ '7767 � Utilities:nSewer Septic Building Height:
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Name of 2a�e 6 A x4ske-/' Name: 606 (, 81'1 w.
Address: 232.. 1'JAjf>,4 roves (3C-,A DL. tof Company: G&A�µ.w ,K f7r .Lti^ Y,v n.'SOivt
City: Fiji a/C.,� State:, Address: Vo3l SW S. Plat" RW..
Zip Code: 3ggfq 2-- Fax: City: P),(I SJ- L.L6, State: FL
Phone No. 22?,- 5 !r- 9 739 Zip Code: 39alL 4 Fax: ?71--`�_7 P700
E-Mail: Phone No. -�?2 - �'7/- CtggV�� /L'�
Fill in fee simple Title Holder on next page (if different E-Mail: 1G,5/i r1re.AAt , tQben-trg JA- Plu-her-Com
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
12/03/2015 15:37 FAX 16002/003
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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 the permit 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,1 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 pr PJ-ert . otice of Commencement must be recorded and postd on the jobsite
before the fi st inspect' n. intend to obtain financing,consult with lender o a toriney before
com ren work or ecQ Our Notice of Commencement. ,:; ,
_Signature of Owner/Lessee/Agent ignature of Contractor icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ��W4'�— COUNTY OF
The for oing instrumen as acknowledged before me The forgoing instrument was acknowledged before me
this day of_ � 20 Lrb, this__S day of ( � 20 45'by
1204ba'KI— ,PA_✓/afiq
(Name of person acknowledging) (Name of person acknowledging)
(Signa a of Nota P lic-State of Florida (Signatur otary Pub' State of Florida)
Personally Kno n ::'i6 Producedr nt ficaL�Aon Personally Known :° f�`°4�.odu&A$khlRi�ibll►YA
z MY COMtJItsSIbN#FF1 Type of Identification r'4d d'.` MY COMMISSION#FF165172
Type of Identificatio P ' e ; Yp
c o er1,20T5— '+ •-a?:' EXPIRES October 1,2018
(407)388.0153 Florid Serv1ce.com or.9,,,.
Commission No. Commission No. 9 .0153 Florid4t;taQservice.com
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS