HomeMy WebLinkAboutBuilding Permit Application Jan. 26. 2016 1 : 10PM Litchfield Co. - Murrells Inlet No- 1245 P. 2
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: Vo-G
R E C E I C JAN 2 6 2016
- - -- Building Pffftflt
Planning and Development Services
Building and'Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 349$2
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential i/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: 901- & ..KQe.t -. Fpr -,�ie-rC.e - Ft- _3 i9$
Legal Description: t (0, L07 CanclQ&
Property Tax ID Lot No.�1
Site Plan Name: Block No.(_
Project Name: (YY,r K C- .0 C-ge "I- be hdrra h A Mc C-ree
Setbacks Front Back: Right Side: Left Side:
=DETAICD 6M.-7606M. O _011 2v� �
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�C ChQrv3e-C LA+ C9 AD(� ly 15 seer V,hee rn Y�U)
C_o.IVST RIJ ;NII_EMR..
Additional work to bortormed un er t is permit—c ec a apply:�W
❑HVAC Gas Tank DGas Piping _Shutters Windows/Doors
❑Electric ❑Plumbing Sprinklers Generator ❑Roof
Total Sq. Ft of Construction: MW Sq. Ft.of First Floor:
Cost of Construction:$ �3SOQ,OD Utilities:0 Sewer L1 Septic Building Height-
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Name Y_IF- 6-1, IdorralA.'l'1'k ame: r
Address:5 1()ViC Mu -T)r. Company: Cook L06 r" uN
city: Fo(-k ' ier[e State: Address:LIIGi 1 SUJ Lk AVe *913
Zip Code:2W9 SQ Fax: City;InaNike- State:Fl..
Phone No, -y(Q(p I(Pq Zip Code: ?moi-'IILI Fax:
E-Mail: Phone No, q6Q—Ci 1- 1155
Fill In fee simple Title Holder on next page(if different E-Mail:'�)e r fYlAS mica;ruYA-CQfY%
from the Owner listed above)' State or County License: ISI ko
IF value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Jan, 26. 2016 1 : 11PM Litchfield Co. — Murrells Inlet No, 1245 P. 3
r =P 1V1�E1VTAl_�Q §T�R�11gT IIi LIE i:' a-N
DESIGNER/ENGINEER; _ of Applicable MORTGAGE COMPANY; ✓Not Applicable
Name: Name:
Address; Address:
City: State: , City: State:
Zip; Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _1,!�'Not Applicable BONDING COMPANY: _!L-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. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
' s
ignature of Owner/L see/ e t Signa a of ractor/License 6114ar
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF" Ov��,r� _ COUNTY OF
The for oing instrumwas acknowledged before me The forgoing instrument was acknowledged before me
this e day of u 20 �(&by thls2 day of 5A 2,0. Q by
AVloA -mt,.m Ett?Z -- y�!< `�C,r f-i,•-e
(Name f person acknowledging) [Namegfpersori acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
.Personally Known --"OR Produced Identification Personally Known r--'--•QR Produced Identificatibn
Type of Identification Produced Type of identification Produced
Commissfon No. Commission No. "a'Yoo •.. E CEQ IYARTINEZ
NG CE IL MARTINEZ f' 1 evi SI F039952
7
p' I 4S� °i•
Revised 07/151 01 °"` p •1 25.2D17 Florida
(J07)398•0153
(�O.�eg�3.0153 ri olaryso 'co.com
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