HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,1 I I �°� Permit Number: on
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Building Permit Application MAS 3 12016
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982 a/
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential /\
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of linernO
PtC)POSED IIVIPR01/EMEIUT LOCgTION
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Address: 1�591 y-'VY£.i'1CC n_Dr - Ft- �3cKg 89,
Legal Description: 2D (LOLL, (0 ( n l L a els1�610(S lbn ndi ar)
PropertyTax ID#: �� c�- �GC� �-` ,DOI i ��- Lot No.Ao 3D
Site Plan Name: Block No. 40
Project Name:
Setbacks Front Back: Right Side: Left Side:
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-DeXYI.ol"l q') oC- 51ir)G1 SLS`'- a4--'of C VlUGi,:I
CONSTRUCTION INI=ORM'ATION
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Additional work toa er orme under this permit-check a appy:
HVAC 11 Gas Tank E]Gas Piping _Shutters Q Windows/Doors
11 Electric El Plumbing ❑Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ J.f� Utilities: _Sewer Septic Building Height:
OWNER/LSSE � CONTRACTOR
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Name YAU 1 4- S LDS Name: Jbho lI.CGr'bZd`.
Address: &eVul'u' l7 Company: 6(b7�-�_V lc, rsS Jim .
City: 1�t' t e(zg State: ��- Address: 511 4,1A) l �_ 1Z1 UG(
Zip Code: Fax: City:- State:TL
Phone No. Zip Code: Fax: 77r�J3
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: -thnU 6)_G
from the Owner listed above) State or County License:C�6C
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
03/31/2016 17:02 17723362272 GROZA BLDRS PAGE 02/02
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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 TITLE HOLDER: Not Applicable BONDING COMPANY: ,Not Applicable
Name-, Naine;
Address: Address:
City, City:
Zip: Phone: Zip, Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
'tioI jCoun makes no representation that is granting a permit will authorize the permit holder to build the subject structure
w,ich'uc isincon lict 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 dead 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,wells,signs,screen roams 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.
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Signature of&6er/Lessee gent rig—natur Contracto- r/Lici#Vs-e Holder
STATE OF FLORIDA STATE7F FLORID
COUNTY OF. SL LA'X'C-J- COUNTY OF
The forgrig Instrument was acknowledged before me The forgoing instrument was acknowledged before me
thi&�15 day of this
7-0 day of
—M!Q1V' !2 ---,20 J.(e by
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(Name 69person acknoig) (Name'of person acknowl4ciging)
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(Sionature"bf Notary Public-Stbjt of Florida (SignaturYof Notary Public-St)of,Florida
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Personally Known_OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced_ of Identification Produced
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Commission No. sw!ievi comill=#F fission Nolp IFNILEY
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Revised 07/15/2014
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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INITIALS