HomeMy WebLinkAboutBuilding Permit Application APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: IT I(e Permit Number: it n
E
A
R —D
E C F J
lies
Building Permit Application MAR 17 2016
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County, 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
W
Y
mlill W11§0
Address: -5 9,4tyo 6 /9-/L)41 J�u
Legal Description: 0.1,
Property Tax ID#: Q � iI OtJQL-) DDD Lot No.
Site Plan N I ame:. J on aj_z�( !2--, Block No.
Project Name: S-+C) C)
Setbacks Front Back: Right Side: Left Side:
R.
a i{ g
p,
01
I 61
N.W1 .1
Additional work tobe nertormea under this permit—cneck all that apply:
OHVAC 11 Gas Tank r lGas Piping Shutters [�KWindows/2oors
11 Electric 0 Plumbing E]Sprinklers Generator Roof
Total Sq. Ft of Construction: So.Ft.of First Floor:
Cost of Construction:$ 2 Utilities:01 SewerF]Septic Building Height:
N V
R Old
gg
Name
Name::.,-
t N
Address: //Y) t+tl U'
IqA)Lr ky A-) Company-Z��Co QQJ-Q,_e&XVC
City: flct L%).0 "State: FL- Address: %a a iQ 1 _79
Zip Code: 2 Fax: City: 1,0 • D��- State:
Phone No.�
14 in 9-- 412 5-6 Zip Code:33ij I Qi- Fax: 51,1 .'a55-OC/0_5_9
E-Mail: Phone No. 05,
Fill In fee simple Title Holder on next page if different E-Mail:
from the Owner listed above) State or County License: 01 G 0
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
J1
•'�t������� f . 1 Y. V�1ij ..,.G� ;�"�3. � it f � �� ��� „ ��k.;,j0.f��� K'�*�g.�* a„� "�K P�r�
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _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 room_ 'd`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
comnoencawork or re ding your Notice of Commencement.
o
s
gnat re-W Owner/-L•essee/Agent 3ignature of Contractor/License Holder
ST E OF FLOR A STATE OF FLORI
COUNTY OF ( )[-, �U� c COUNTY OF M RPo c h
The f rgoing instruiment was acknowledged before me The forgoing instrument was acknowledge)pefore me
thislday of 20 I Itby this-16—day of War. 20 /(e2 by
i nd,&-, J at2xE Dnvi 5
(Name p son acknowledgin (Name of person acknowledging)
S' n re f Ngta ub' f Florida) (Signature of ary�Publ�c-State of FI Ida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced �c
Commission No. •'�i� " �yLffiRA)�T� Commission No. _4%y?&A. ANceLAYO[;Eal)
2 O
'� aill SUN
''' AtV COMMISSION R FM14UO , ,� MY COMMISSION#FF 951069
EXPIRES.Ap h 12.2020
sapamm
7 ••• ty� 'Zulu
�P�tlF fib IJW0d Thry®ud®ot Notary 3erAm
Revised 07/15 '°"
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS