HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2-411.0 ..Permit Number:
RECEIVED
Bufl g PerMft Appikatic' n FEB 01 2016
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie Cou , 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
PRO'POSLD�f' '�'�OU'EMF;I�1�taCATI+DN{ � �{F �'
Address: /!fie 71-/e.
Legal Description: Of 9yo a---,So I - C-'7 p --Opp -
Property Tax ID#: 0,2-S'6/- O 3 rL- pop - Lot No.
Site Plan Name: Block No.
Project Name: M,-- okli;14
Setbacks Front Back: Right Side: Left Side:
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DETAILED DE'SCRIPTI'ONY OF W40RK' j x �:
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CON`STRUC`fIOIV INFORMATION
Additional WorK to Depertorme under this permit-check a' a "
HVAC _Gas Tank ❑Gas Piping _ pp Y:
Shutters Wind o Doors
Electric Plumbing OSprinklers I Generator oof
Total Sq.Ft of Construction: /60 S . Ft. of First Floor: /06
Cost of Construction:$ � 7iOD• DD Utilities:cnSewer Septic Building Height:
O1fVNER/LESSEEON
C TMCTOR
Name ,�b�orR!-I ,� er- Qui rLry Name: U C✓
Address: �S' /i/� Company: F1 O ( DfT C
City: --re V7 C e VJ 09tom (� State: FAddress: SW ,., ,� Ave
Zip Code: Fax: City: O/Hy L�G�C State: ltc-
Phone No. Zip Code: 50 13 Fax: 77,2-.7y Y-71-5'�
E-Mail: Phone No. -7 / -7
Fill in fee simple Title Molder on next page(if different E-Mail: %�1 L � r'Oe/�fU+�Th-
from the Owner listed above) State or County License:--CCO T? f
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
��ur�.�P� ��1T�z eow��r��rr-r���;���4�s�►w��r��o� � �� �� � � � � , t s � � a .
®ESI�Gt�E6�/ENGII�EEIi: _Not Applicable OE�TGAGE COi�1PANY: _Not Applicable
Name: Name:
Address: Address:
City: tate: City: State:
Zip: Phone: Zip: Phone:
EEE SIMPLE TITLE HOLDE _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
Irtify 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,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.
G'
_Si ature of Owner/ ess 'e/Agent Signatu Contractor/Li rise Holder y
STATE OF FLORIDAr �� STATE OF FLORI A /
COUNTY OF L COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this I day of V 20114Lby this I day of F 20 by
hi LR nth unu Pert
(Name of person ackn wledging) (Name of person ack ledging)
r
(Signature of Notary Public-State of F orida ) (Sig ure gy Notary P lic to of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identificption
Type of Identification Produced I Q�l� Type of Identificatinn Produced
Commission No. -Z I ounr ,,-0 o; y�q, sion No.� (� .•t�,P.-% Sea KAITLYN SALIBA
S@J! x3 uoisslwwoo AV _ s� ��
_, o•: Notary Public-State of FI da
KAREN S. NIELSEN LEHI.I. 33 # uoissiwwoo - 3�
o: .eCo
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fission Expires """"` �z My Comm.Expires Jul 13, 1S
p�x,j� }�} a r
eCl V/(�} Q 14 o 1 8 '��m�• Bonded through National Notary sn
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS