HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: &U -
Building Permit Applicati®n OCT ? 1
Planning and Development Services
PERf.AIT IVIG
Building and Code flegulation Division
23t►DVfginiaAvenue,Fort Pierce FL34982 St. Lucie County, !=L
Phone:(772)462-1553 ...Fax:(772)462-1578. ._. commeCCiat. .. Residential... . ,
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of tine
' Pt� EC�IMC1�/ES-' S a -s
P-1-
N'
,.
Address: LH W 14 AAA AP± 3q-A
Legal Description: (#'en-Si ire 00ye '(Ji. nes u 1 l i 3+-�
PropertyTax_ID#: €�- 3` 1 ." � - P Lot No.
Site Plan Name: "TI'C=CL5UtV~ 0-OVe Block No.
Project Name: 1 _R(f Sldenc'.-
Setbacks Front Back: Right Side: Left Side:
.,.-s_rs <-.3.=v�x�.<v�,�"�. .�... .tea.»,_ae _,._, ., .,.. .- .�,_s> a. ,,.... . .�,._,-x�,2. 7_x:;.as...�xn`�,.+ ...L_>�„w;.,., .�..,�L•x Md
i" G. rc.pinLe (s) W r?Clevi vq i+h i rrvjc--.
(`✓y�.,r�,,,x �::-,� a"+<,a� pj� {-xj j��j..v s���p:.�<t� .3 �� #x �,,�"�t�'��. ��`3 ��t1� 1�.� r��� �•i��{�� t� z;,��,s.`L��t��'�'�`''.-:� r �
ll(2r�a v+t.4t
L�,,.IHVAC H Gas Tank E]Gas Piping _Shutterswindows/Doors
�Electric Plumbing •Sprinklers L_I Generator o Roof
Total Sq.Ft of Construction: SFt.of First Floor:
Cost of Construction:$ Utilities:cn Sewer Septic Building Height:
.mss Y.,, a + q
Ol[ ER/LESSEE s a CONTRACTOR a�a s vx a 4 kF
r�Y .:w..S�S..�>_.a,:..
wame -'Renee,' j 4"i!"� Name.:�, fid.€��.rt•s�� ��.�.
'Xddress '�t iyr nt i0m.k�
State -
:Address
'zip '
State: LC31
i hane�IVo ,�i q Zip Code: i� �I Fax: Zed $ I €
E-Mail: Phone No. '7
Fill in fee simple Title Holder on next page(if different E-Mail: Y M i fSg"1CkSS JQS ('Q('-M 0 X Cr0*')
from the Owner listed above) State or County License: i tic
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
>rs „x & „nscNMI-
05
; -
SO PPLEME1tlT L i�ST�RIl0 16-N-1,10r �L� {�INFO,�IuIA�I"�3�� �p
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 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.anposted on the'jobsite
before the first inspection.if you intend to obtain finan ' consult with lender o gin attorney before
commencing work or recording your Notice of Comte Ce .. nt.
P� 1"ze } s
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder-
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF I � COUNTY OF_0. I avkh
"�A I
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
._...this: --da of._ ............
(Name of person acknowledging) (Name of person acknowledging.)
A,0(la-, Lre
(Signature-of(Signattim-of Notaff Public-State.of Florida} . (Signature of N ary Publlc=S to of Florida)
Personally Known OR Produced identification�`/ Personally Known OR Produced Identification
Type of Identification Produced-IZU1 06 DL Type of Identification Produced
Commission No. (SeaELLY WIDMAN
�� �� a� I mmissi n No. �,•�N`�P,,a��,
o�a1�""�;I �} KELLY WIDiP o, N Lary Public-State of Florida
c+° ¢ Notary Public-St a of Florida 1;01111 Won iK FF 929255
�.� m. xplrea Oct 20,20x.9
My Comm.Expires Oct 20,2019 �,°„ �` f�flfldldih0U�lNrlOilyNOf
Revised 07/15/2014 %4;;; A�ml
BOnrir!,:;hrnu: N.Mtlnnal Wary Asn ry
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS