HomeMy WebLinkAboutBuilding Permit Application 12/18/2015 14:50 FAX IA001/003
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 115- Permit Number:
N�tMV "ECEIVED
Building Permit Application DEC 2 12015
Planning and Development Services PERIAIT71NG
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-I553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Legal Description: ltiV" C'A — U
Property Tax ID#: '34n-540- b 3q:J: - 1506 - 9 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertormed under this permit—check all Mat apply:
0HVAC Gas Tank F]Gas Piping F�Shutters F]Windows/Doors
FlElectric Plumbing ]Sprinklers IiGenerator Roof
Total Sq. Ft of Construction: Scl. Ft. of First Floor:
Cost of Construction: $ Z 4). 4170 Utilities: F]Sewer F]Septic Building Height*
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Name
Address: 1?6 6&nA �i_-
City: a,/- r5 - - State:_)EL Address
Zip Code: tWf2r3 Fax: City: 24d c X L,1 , State:
Phone No. 222-- '2i7r- 161?e2 Zip Code: Fax:-:27 Z F7
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: 4-DMAa.*,,Lkj IQ�enAAA, P1vo--1,ey-(4
from the Owner listed above) State or County License: 4-1
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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12/18/2015 14:50 FAX 10002/003
7Address:
d,. i«A +.+'..DESIGNER/ENGINEER: Not Applicable ORTGAGE COMPANY: Not ApplicableName: ame: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 inspe ion. If you intend to obtain financing,consult with len Y..or an attorney before
comm cin work ecording our Notice of Comm enceme .
s
`Si nature of Contractor/License Holder
Signature of Owner/Lessee/Agent g
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged beef re me The forgoing instrument as acknowledged before me
this day of _-P e 20 J by this 1*7 day of 20 LE:by
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(Name of person acknowledging) (Name of p6rson acknowledging)
(Signat otar -St a of Florida) (Signatur of tary Publi tate FloridaPersonally Kno 5L��bll
)OR Produced Identification Personally Known��Produced Identification
Type of identification P Type of Identification Produced
LE�;LI I� ZELAYA
A MY CCIGiiS Commission No.
Commission No. tON#FF1sst�2 ?o'..,. °;;'� . L Q ZEL.:
EXPIRES October 1,2018 My COMMISSION ifF
390,0153 FloridallolaryServt(.a.corr, EXPIRES October
Revised 07/15/2014 (407)s�e:ot :i FlorlticANotaryServi;::
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS