HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST
BErt !COMPLETED FOR APPLICATION TO BE ACCEPTED
t, Date:—= .�=� 11_i Permit Number:
RE CE,
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Building Permit Application MAR 0 7 2016
Planning and Development Services PER!'/iITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fart 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
Legal Description:
TRACT MP DAHARRIS A BL:Ei`2 THAT PART OF UNNUMBERED
TRF:FROM SW COR LOT_10 RUN E 170 FT FOR
POB TH CONT E 84.97 FT,-TH S25 DEG 50 MIN I I SEC E
Property Tax ID#: :?1*7 :5 WITH W R/W INDIAN RIVER.DR I33.34 FT TOA PT ON A
�✓ --�- CURVE CONC TO S,CA OF 94 DEG 35 MIN 01 SEC AND A OF
Site Plan Name: 45 FT,TH RUN WLY AN ARC DIST OF 74.29 FT,TH W 13.95
FT,TH N 26 DEG-05 MIN.V//TO ELY R/W RIDGEAV 145.09
Project Name: FT TO POB(OR 3827=427)
Setbacks Front Back: Right Side:
DETAILED DESCRIPTION CSF WORK s r '� y£ ?'R
1COI >R}tJCT�;� INrF,O,R`�tliA-��fC►N
uAc1clitional work to beerformeclun er t is permit-c eck all that appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
QElectric 0 Plumbing Sprinklers [Generator o Roof
Total Sq. Ft of Construction: SIn of First Floor:
Cost of Construction11:$ t Utilities: Sewer Septic Building Height:
OWN'E /LESSEE CONTRACTOR '`�
r.�.��,
k
Name _U 1. I �}`�+`�_ e1A ti �= Name. _
Address:_ :.CACI i t'C,. _ - Company:
City: j „ 1.-gv-CQ, State:J Address: NX ,
Zip Code: t✓ .;Fax: City: �- c�fC"(-Q State:
Phone No. r`t J Zip Code: <3L-I J J' Fax:
E-Mail: � Phone No. t Go - t;.� � -t a
Fill in fee simple Title Holder on next page(if different -Mail: �%_X � L) � m
from the Owner listed above) State or County LLicen-e:
If value of constructidn,is$2500 or mare,a RECORDED Notice of Commencement is required.
SUPPCEMENTAI.�CUNSTRUCTION LEEN LAUD fN•9. INT0
,r y K
1 Vs ``' 4 w r '
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: r 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 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.
�--
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF .�v ,l�, COUNTY OF ?C�,(C,
The.f r oing instrument w s acknowledged before me The forgoing instrument was acknowledged before me
this r7 day of 20 4by this day of )?M 20 by
(Name of person acknowledging) U�Y �IS (Name f person acknowledging}
in
�jc9--`�.
Si ature'of Notary Public=State of Florida } (Signature of Notary Public-State of Florida} /
Personally Known_ OR Produced Identification r Personally Known OR Produced Identification I/
Type of Identificati�,n Produced -Vl Type of Identification Produced
Commission No. jQ I_b"" ''B�cf KAREN S. l,Hgg�io o. r( (Seal} 4
Commission ), FF 115637
My Commis ion Expires ,ap,p� KAREN S. NIELSEN
My Commission Expires
Revised 07/15/20,14 �;',yro��` June 12. 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER 'REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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