HomeMy WebLinkAboutBuilding Permit Application 12/16/2015 14:19 FAX 9001/003
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12;.(16 1 15 Permit Number:1�1_L�' �7
Building Permit Application DEC 16 2015
Planning and Development Services PERfvilTTING
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
NO
MISS
Address: -7.8 CS Wo r V-.0-I � {� {,� `a �k (',o C; Fr< 3tix
Legal Description: i=a uIe`S ftp' n7� �5avannc. ,Gay„ pti a C3 Lf 2i (�L k- y
Lo 4-.4 ( or �aq-
Property Tax ID#: 30 21-f- -?p Z_ j)p bS- OCka- rj - _ Lot No.
Site Pian Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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-etione�eme un er[IGas pec a appy0HVAC Gas Tank Piping _Shutters M Windows/Doors
—Electric Plumbing Sprinklers ElGenerator Roof
Total Sq. Ft of Construction: SQ. Ft.of First Floor:
Cost of Construction: $ 1,)--W . 06 Utilities: Sewer l]Septic Building Height:
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NameJc7 , � �� Name: 1�Es a
Address: '� 1UTVr4.s.� �tr�( Company: 4!► b;
City:_ 6 17`4. Lc tt„ State: (_ Address: _6W Jes t, MaC c�a S lu d
Zip Code: Fax: City: Da(� 5+. L V--ZZ. State:
Phone No. Lf12- 0LA( 1 Zip Code: '34q 34- Fax: 7 x'71 . 106�j
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
12/16/2015 14:19 FAX 17002/003
moA
GIApplicable
. .
DESIGNERf ENNEER: Not A �t�a
pp�'cable . 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 Horne 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. ! you intend to obtain financing,consult with lender <an attorney before
comme work or re our Notice of Comm encement,,;�'',
s
'-'Signa,.&re ` Oer/ _ ____ +gnat a�f`Co" ractor/License Holder
ssee/A '
STATE OF FLORIDA / STATE OF FLORIDA
COUNTY OF ;�j;" /�.-C :'' COUNTY OF s7 .c .
Theforgoing instrument s acknowledged before me The forgoing instrumen was acknowledged before me
this /6 day of eS20 �y this /k day of� (P C_ , 20 _JLt�by
(Name of person acknowledging) (Name of person acknowledging)
f
(Sigpla5t of Notary Public= tate of Florida} (Signature of Notary Public-Stat Florida}
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification
"� _.""" t'"•'`°'' LESLI D ZELAYA
`*a.e°�` _ LESUd�1)ZELAYA _:� x, `
Commission No. �° �,;:_ Commission No. MY COMHN #FFSG5t72
- MY COMMISSION#FF165172EXPIRES Ortobe, EXPIRES October 1,2018
(407)398-- foridaNctaryServiCe.coln
Revised 07/3.5/2
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS