HomeMy WebLinkAboutBuilding Permit Application 12/28/2016 09:09 7724626448 SLC CODE COMP PAGE 03/10b
ALL APPLICABLE)NFO MUST BA COMPLmr)FOR APPUCATION TO RE ACCEPTED
Date: J1, 1 J,, - 4
Permit Number, t LO 1
RECEIVED
Wilding Permit Application DEC 2 8 2016
Planning and Development SerVJM PERMITTING
Ouildurg=4 Code Regolotion DUston St. Lucie County, FL
2300 Virglam Avenue,Fart Pierre FL 34982
Phone:(772)462-1553 Fax:(772)46Z-1578 CornmerCtal� Residential
PERMIT APPLICATION FOR: TO Sefectfrorrl dropbox,0110k here,
PROPOSED 1NPROVEMENT
Address: �
Legal DescriptIon:
/i � �I�"" 0t
Property Tax Id#-. L+ �c �.Jt.�-� - Lot No -1�__0Z�
Site Pian Name: Block No.
Project Mame: fZ
Setbacks Front,— Bach: Right aide: Left Side:
DETAILED DESCRIPTION OF WORK:
Aim /Tax.fl—
CONSTRUCTION INFORMATION:
Additional wdr t0be orme underET: ,i1– c a appyEJFNAC GasTank1plttg 5htltters Window oors
nElectric Plumbing OSprinklers CGenerator Roof
Total Sq,Ft of Construction: .Ft.of FirstFi or,
Cost of Construction:$ Utilities Sewer USeptit Building Height:
OUVNE / EE: CONTRA -
Nan' Name-
Address ' co mpa�y., � Ll
City: V112 4, ffZ2
'1 State,-t- / AddressWe
Zip Code: F4 City. State.
Phone No. Zip Code: Fax:
E-Mail- Phone Na.
Fitt in fee simple Title Hairier an next page(if diffarant E-Mail:
from the Owner fisted above) State or County License: Z 7195'277-7
I Ill
If value of wnXh-4%ivn is$7500 or more,a REWRWD Notice of Commencement 4 mquired.
12/28/2016 09:09 7724626448
SLC CODE COMP PAGE 02/06
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER aC'INBER: ^Not Applica aMORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
ZW Stalte: Cary: State:
P: Phone: Zip;--�Phone
FEE SIMPLE T1T111MOLDER: ____Not Applicable BANDING GQMPANY: _„_,Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone, Zip, Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit
St,Lucie CouniY maiEes no representation that is$rant' a Permit will authorize the ermit holder to build the subject olicture
Which is in con ict with any applicable Home owners> ociation rales,bylaws or anti covens m that may restrict or prohibit such
structure.Please consult with your Home owners Association and review your deed for any restrfetions whish may apply,
in consideration of the granting of this requesstted permit,I do hereby agree that I will,In all respects,perform the work
in a=rdance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The follow building permit applications are exempt from undergoing a full can rrency review;room t►dditions,
accessory ctures,swimming pools,fences,walls,signs,screen rooms and a ry uses to another non-residential use
Sore
RNiiYOWNER:Your failure to Recend a Notice of Commencem tmeYres ' Your paying twice for
rove e stoyour pr perry.A Notice of Commencement must ecorded n posted on the jobsite
th fi insp oh if you intQlld tR 0$Eein firiarfcing,consult a lender r a attorney befare
commen tjrk or eco ing vour Notice of Commencement.
Signature of D er s® •���«. ignature of Contr Ai Anse Holler I
STATE OF FLO a _ TATE OF FLORi
COUNTY OF 3 •• OUNTY OF
ifN1 Mate
The Ing Inst ckn ed d before 42 e ng instr j s 11woviled b
this day of 20 by 3 c his day of 2
WNW-
(Name of pe=so kF
;0 ame of p a nowledging)
ywi
4a o r
r
t
(Sknatupr6f Notary blio-State of Florida) ` (Signature of Notary ub' State of Florlda)
Personally Known OR Produced Identification Personalty Known OR Produced identification
Type of Identification oduced Type of Identification Produced
Commission No, (seal) Commission ND. (Seal)
Rcv'ised 07/15/2014
REVIEWS FRONT ZONiNG SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATI
COMPLETED