HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z- S 1 Permit Number:
RECEI'."1 FEB 2 5 2016
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Plerce FC 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of linea
Address: 3"i�. uop�a� l.araE
Legal Description:t?AJ yA .51cL G L oT 9
Property Tax]D#: 3'410 S "�� 41Ai-j rQ pa- $ _ Lot No.i
Site Plan Name: Block No. G
Project Name:
Setbacks Front Back: Right Side:._._._ Left Side:
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Additional work to be perl meduffider this permit-check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
UElectric ❑Plumbing []Sprinklers Generator Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ 4 O Q .bo Utilities:0_Sewer Septic Building Height:
NMI M51,111
Name 'boy CG 1 RYAIy Name: AL-vv%eLdA
Address:J~18. 1-:u?6 PEQN LV _ Company:Cten,w Qi2 bGcHNoLoo����
City: �CL+T_. eivr C Statefir,L. Address:laZ� NI m )eErz c+a{ -
Zip Code:144 Fax: City:. 1�ORT s rZrx1& Stater
Phone No"n1l.- 44b4a- n-J L4 b Zip Code: 3k!J t5�Z-- Fax:`Y) s =06'l
E-Mail: ' Phone No. �`+'�'2- 33 5 :?_0 6
Fill in fee simple Title Holder on next page(if different E-Mail: C,( A u "C'19 (PJ AbL_.cb rr�
from the Owner listed above) State or County License: Q0 C.A S$860
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: _ Name:
Address: Address:
City: State: City: State:
Zip: Phone: _ zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize thepermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Horne Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,1 do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida$wilding 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
commend ng work or recording our Notice of Commencement.
42�y�. 'A�zz s
re of Owner/Lessee/Agent Si a of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF S's Lva= co'l""N COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this d,5 day of 1706of_! it , 20 L16—by this 2+<dayof IFCSuRA&!i 20 L)4�by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
PersonallyKnown Pro i i Personally Known' o4*•"Y rod!$ArNlI AiWALSW
Type of Identificati 'r Type Type of Identificatioi o WIF091118
ril.1l 2018x` EXPIR(= April 11,2078
EXPIRE
Commission No. .o►�..+� ��R � Commission Na. Fiar
(40n 3w-0163 Floridallotary^eivioe.com,
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
99t—A £000/3000d 9L9-1 —WOU Z9=60 U' 9Z—ZO