HomeMy WebLinkAboutBuilding Permit Application 772-801-5398 P.1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I 0 dig_
Date: MALA 7 5 2401(. Permit Number: ''I
Building Permit Application MAY 2 6 2016
Planning and Development Services
I PERr:qI'I i INC
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:
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Address: 410_:�r -TV/'n F ke Fee deX lZc/ ' r 71
Legal Description:
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Property Tax ID#: ? l - �Ytr CW7 !� Lot No.
Site Plan Name: ! Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Chi cC;'X^ec'� CL'+ I� i-lerf n^1N GASI S[ (14A0/kooA
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iti na wor o e e Orme un er • is perms –c ecc a appy:
HVAC Gas Tank ❑Gas Piping _Shutters I ]Windows/Doors
Electric El Plumbing ❑Sprinklers E Generator Roof
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Total Sq.Ft of Construction: S . Ft.of First Floor: i
Cost of Construction:$ Oa Utifities: Sewer Septic Building Height:
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Nameleje,e go .- v M4hoI)s� Name:_ (�'�o�}r►�ai✓�' A,r e `( L
Address: :5�ko S JrvelnnFke 9ewJ t! ,�. 'Company: 2 3 5,5 A✓c _SE
City: -c—f ;;ee State: J Address:
Zip Code: 3 Li 4 5-/ Fax: City: Veld 13 e G c4 Stater
Phone No. ')'1 1 Zip Code: Z '.i Fax: I S3 c1 g
E-Mail: Phone No. –17Z,' 4T10–
Fill in fee simple Title Holder on next page (if different E-Mail: �5'A1/-)?_314 a),(1-IUAC_ Wr ho-b . ca
from the Owner listed above) State or County License: 1016,71r)
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.;
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772-801-5398 p.2
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY'-'[ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone1
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name: hE
Address: Address:
City: City:
Zip: Phone: Zip: Phone:"l
I certify that no work or installation has commenced poor 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 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:w:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
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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 your Notice of Commencement.
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Signa re of 0hrier/Lessee/Agent Signa-tq(e ol"Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA IRW
COUNTY OF. COUNTY OF In"An,
The forgoingIn rqrnent was acknowledged before'me The forgoing instrument was!acknowledged before me
this
his Of 20 4by this.W day of_ft1%A 20 by
Nwynw
(Name of person acknowledging) {Name of person acknowledging)
R
Ins ru ent was
of
(Signature of Notary Public-State of Florida (Sig tore of Wcfar�—Public-State of Florida)
Personally Known OR Produced Identification Personally Known 2S OR Produced Identification
Type of Identificatt n Produced
Type of identification Producle'd
Commission NO. I oval I mission No. eal)
1016AIMM!" HEATHER M,—::
NOW Pdft-stsoft Cot Nwary Public-
Commildo 0 FF-10?28
Revised 07/15/2014 fAy C"ft Ew"in 19.20111
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATIONJ
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COUNTER REVIEW REVIEW REVIEW REVIEW REV REVIEW'
DATE
COMPLETE