HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE I ?O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C-� Permit Number: SCJ
•
Building Permit Application OCT a f 20161
Planning and Development Services PER:UiITTiNC
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`nc`ows
dc:OP's
PROPOSED IMPROVEMENT LOCATION:
Address: 17_:�-I NW I.Sh ClY-C',1-P. Pcckm C 1 U I EL_. 3lIgg()
Legal Description: 44arbouu r Ri0A c—p1QJr 1 - Deet_ HOSS /1 110,00 LQ::4
PropertyTax ID#: Ll-Ll- fo -8315 - 0015- O0a"' Z Lot No. S
Site Plan Name: aA IKLLP ReSi(Jf-n(k° Block No.
Project Name: fiouKu f) -Re-�,iaeOC_t
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF:WORK,
_Renr-b,/e arm reploac-e ((c,) windOW3 anof (1 ' en+-Y y dam.
-9 Ckfe- o otc:A—
c>-� e ,>,_ k_s --
CONSTRUCTION• INFORMATION:
Additional work toa performed under this permit-c ec a appy:
HVAC 11 Gas Tank F]Gas Piping _Shutters Q Windows/Doors
Electric ❑ Plumbing ❑Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ Utilities:]Sewer E]Septic Building Height:
OWNER/LESSEE: . ;:u CONTRACTOR:
Name._;6*W 'kb4 T Pn �uKt LP Name:
h IP
A'd'dress: 1'137 NiNjL,Ln'1bl,LSEI CtrC18Company: S �resSlOnals
City: YYI r� State: Address: -35'7,0 .5 ,,;.n1.Xl e 4 Wy
VZ
501 .Fax: n c- City:r� i.t,'a 1 .b;..:., ., ' ... State:_
.�._
Phone No. 919 -Wb- ICQ7 Zip Code: ',9t1Ckq'7 Fax: aE�(b-04-toI
E-Mail: Ksalkkl�nl3 an�mC��G rccxYl Phone No. -7-72. 7-86 0e4•5l�
Fill in fee simple Title Holder on next page(if different E-Mail: panua+s.ct JosspmsQ_ mn,_eD cc+rn
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. d co
SUPRI.EMEIVTAI�CC?NSTRUCTION LlEIU LAW INFORMATIfJN.
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 and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or ttorney before
commencing work or recording our Notice of Commence
s
Signature f 0-wrier/Lessee/Contactor as Agent for Owner Sig ure oftontractdAAfrcense Holder
STATE OF FLORIDA ' STATE OF FLORIDA
COUNTY OF i1')nY+In COUNTY OF mar+-i n
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of .7epe_n ber , 20 Lby this Q day of 20 1(D by
�1i n 1 �ouL t,t p
(Name of person acknowledging) (Name of person acknowledging)
J \ 4 U �J&PAA
(Signature of Not&y Public-State of Florida ) / (Signature of Notary blliic-State of Florida )
Personally Known OR Produced Identification v Personally Known ✓ OR Produced Identification
Type of Identification P Type of Identification Produjoy -
KELLY WIDMAN ""Y"''� KELLY WIDMAN
Commission No. •'r° 'o•, Notaryd?ad)IIc-State of Florida Commission No. (J�f yl)Publlc-State of Florida
• Commission FF 929255 =_•a = Commission*FF 929255
M Comm.Expire Oct 20.2019 M Comm.Expires Oct 20 201
Bonded through National Notary Assn. Bonded through National Notary Assn
Revised 07/15/201
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS