HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE'COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: to Permit Number: �n OLI -0
Building Permit Application APR 2 8 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
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Address: 350;3 s I ow) P8, kf_ccel Y__L 34q4-7
Legal Description: Gorcen G �m D6 35 go u-) So-F+ cff' 18y f7+,,C_S
PtcY of"aq!5- 494 , 51g-13a)
Property Tax lD#: g9L40q- L0o8-0173-300-Z Lot No.
Site Plan Name: Block No.
Project Name: 6,1AL hyo )
Setbacks Front Back: Right Side: Left Side:
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T�o_r 0+4 s 16 f' -A oo 'rsh-a ac5_14n9 k r-oov
Additional work toE1rtormed under this permit-check all that apply: Windows/Doors HVA bene []Shutters F
0_ Electric El Plumbing []Sprinklers 1-1 Generator Roof
Total Sq. Ft of Construction: /&16Y Y S Ft of First Floor:
Cost of Construction:$ 2900-00 Utiiities*Pn Sewer F_1 Septic Building Height:
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Name_L�AQ D,Xro n Name:
Address: ' 50 51 0a'n Company:-Ali Ek-eA
City: Lecce State: Address: 1 S I-LS -HWSJ I
Zip Code:- 3Lt9 tA-1 — Fax: City: RWC-e- State:
Phone No.__3 21 -aa 5- 1 Y(oO Zip Code: 3LIWOL Fax:
Z�-L4 ID 14-L[oD()
E-Mail: Phone No. -7]Q-W(o4_Lp8co
Fill in fee simple Title Holder on next page if different E-Mail: ► c_,n(it Vtfg QJos-,_90- (1c)"
from the Owner listed above) State or'-'C/ounty License:
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 TITLE HOLDER: _Not Applicable BONDING COMPANY: Not App livable
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 appl y.
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
commeyOng work or recording our Notice of Commencement.
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Signa ure o caner/Agent/Lessee Signature o ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 54, I AA C11 Q COUNTY OF Wil+, Cep
The forgoing instru ent was acknowledged efore me The forgoing instru ent was acknowledged before me
this�day of / r7 20 1 by this o'/D'�day of 20_L4 by
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(Name of person acknowledging) (Name of person acknowledging)
/A D AA AA XhA
(St nat re o Notary P blit-State of Florida) (Sign tur of Notary Public-State of Florida)
Personally Known_ OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
°;.
ePp
a ••.°"9 JENNIFER OBERT JENNIFER OBERT
EXPIRE$;November 12,2016
a-
Revised 07/15/2014 9TFOFF �\OPBonded Thru Budget Notary Services s, EXPIRES:November 12,2016
�TFOF F�°P� Bonded ThN Budget Notary Sakes
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS