HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I P2 ' 1(.p Permit Number: r
o 93
a/ RECEIVED
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Building Permit Application NOV 2 3 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 X— Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED INIPR01/EMENT LOCATION
Address: 8-720 3 C:)C{AN �/2/✓� g 3
Legal Description: 15 t-"O �L�UNirS � tirx� p- Ury tT 9 33 A•��-
AOM,2& 6.860--- /®d 1C3S=7 .1
Property Tax ID#: �5� 'CQ�� ��lam ( ' Lot No.
Site Plan Name: Block No.
Project Name: � �/ /�
Setbacks Front_ Back: IV1A-Right Side: 1 Imo— Left Side:
�D; TAILED DESCR)PTION CSF WORK
CQNSTRUCTIpN INFOR)119ATION .:
itional work toe e orme un er this permit—check a appy:
HVAC Ei Gas Tank Gas Piping _Shutters Windows/Doors
11 Electric ❑ Plumbing OSprinklers Generator _Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 5 ZOo `� Utilities:cn Sewer E]Septic Building Height:
OWNER/LESSEE b z CONI"RACI'OR
r
n. 3_su
j Name Name: A ,c.!h,t
Address: 8:7513 's roGgo,,.) 74. 8 Company: -Tkm6N V129� 4 Gf4666mi
City: :]aZFN1 _3L-4w,4 State:_flC Address: /72p Nv) rf22 E77.rft�
Zip Code: 3LiCi'E�—€ax: City: n�UPc✓t.. — Stater
Phone No. I 1 �5° Zip Code: 3 t l !i A, Fax: 6A2—c(?L(Lf
E-Mail: Phone No. (09 12 —0OG2 0
Fill in fee simple Title Holder on next page(if different E-Mail: �n�.✓;n. tis1
from the Owner listed above) State or County License: �.� t�f)
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
:.S'UPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 failur to Record a Notice of Commencement may result in your paying twice for
improvements to your prope ty. Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. yo intend to obtain financing, consult with lender or an attor ey before
comme In work or ec di our Notice of Commencement.
S
Signatur of Owner/Lessee/CoAfrac tnfior ner Signature of C actor Li ense o e
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF —':;i , OCII COUNTY OF S7— -l>ClF
The forgoing• strument was acknowledged before me The forgodi�n instrument was acknowledged before me
thi��? f���//' 20`�by thia�o�cf�yof /J'J)// 20�G by
zz
(Name of person acknowledging) (Name of person acknowledging)
(Signature o ry Public- tate of Florida) (Signature o etary Public-State of Florida)
Personally Known t,--'OR Produced Identification Personally Known kl / OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seall Commission No. (Seal)
,=oit'.PVgc^ ANN M.GAUMOND ,.• , ANN M.GAUMOND
:*= MY GUMM16810N#FF 173907
EXPIRES:December 7,2018 EXPIRES:December 7,2018
Revised 07/15/2014 I;F ,e BondedThruNotaryPublicUnderwriters :e.••..oc=
„( �F ,.•` Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS