HomeMy WebLinkAboutBuilding Permit Application 1012512016 TUE 12: 07 FAX _ 01f005
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10,25-AG Permit Number:—UC2] pr 03?5
R M E 11-7r
Building Permit Application OCT 2 5 201G
Planning and Development Services
Building and Code Regulation Division PEh;AF17114G
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie County, FL
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERM[ APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Property Tax ID#: M-- Lot No.
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Project Name:
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itiona war to (elieortne un ert is permit–check al y:
OHVAC L�1 Gas Tank FIGas Piping _Shutters 11 Windows Doors
®Electric O Plumbing FISprinklers Generator o Roof Roofpitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Ut if iti es: S ewe r Septic Building Height:
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Name ATf Name: r1/ODQW o�rrrrort/
Address: 3Zq /JGf/ �j,C/f
Company: DyrvA/1v/c /G/friV6
Address; 263 ,¢FGRo/Zr;� p r
Zip Code: y"y Fax:_779 04'l7• 7,17G City: LGf3G6d/c'/fi State:/42-
Phone No. 772 la l.2 y2Zc� Zip Code: Fax: 32�r�s� 09s8
E-Mail: Phone No. 121•2SS 0J'J7
Fill in fee simple Title Holder on next page(if different E-Mail:
from;he Owner listed abo rQ) c*are ur_t;! censeGt
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
10/25/2016 TUE 12: 07 FAX 2002/005
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Appl' e
Name: Name:
Address: Address:
City: e_: City: State:
Zip: Phone: Zip: Ph
FEE SIMPLE TITLE HO _Not Applicable BONDING PANY: _Not Applicable
Name: Nam
Address: A ress:
Cit City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie Count 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 wi or an attorney before
commenci ork recording our Notice of Commencement.
s
igna a of ner/Lessee/Contractor as Agent for Owner gn ture o C nt or/Lic older
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF_ /���d�Y2A
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 7-5^day of ala-1 f/f 20 Lby this 7_5 day of 20 by
4501 1 �i 4lAr y r_-el,
(Name of person acknowledging) (Name of person acknowledging)
( ignat re of Notary Public-State of Florida) (�igna ure of Notary Public-State of Florida)
Personally Known 0 P Personally K own_ OR Produced Identification
Type of I n ro ucLOUIS �'H Type of IdenIiLd
Commissi a Notary Public•$ta `ot b Ida Commissio �� �= LOUIS K IATU I
' am alon I?F .` ubllc-Sta Of Florida
-, -My Comm.)I0res May-29;2020 �r Commlaelo
�cn*FF 968057
Revised 0 /15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS