HomeMy WebLinkAboutBuilding Permit Application 12/29/16 06:21PM EST '8666027933' —> 7724621578 Pg 3/5
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN E 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 wiH 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 an attorney before
commencing work or recording our Notice of Commencement.
G s
Signature of Owner/Lessee/Contra or Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF W&IC, COUNTY OF S�- Ludt
Theforgoing instrunlent was acknowledgeq before me The forgoing instrument was acknowledged before me
this day of �M 20 by this day of u 20L(V by
16rS : yyya I[Y/s�h /�0�/y
(Name of person acknowledging) (Name of person acknowledging)
A h
''r
— 'A
(Signatuotary Public-5 e of Florida) (Signature f Notary Public-State of Florida
OR Produced identification ersonally OR Produced identification
Type of Identification Produced Type of I en cation Produced
�►r 1JXGdIArd
.Pkrru�, PAMDARES '
Commission Noe~••'�y�4+ "al) Commission No. •'"•"�4+
Oo681s2 659�oM# e.
' E7�IRE3 luny 1,2020
'" EXPIiiES:DaaMillm 18,2020
OF{� eftw iMI BLOWNOYSORAWS y
Revised 07/15/2014 '
REVIEWS FRONTZONING 'SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
" COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ff _/�
Date: q' o Permit Number: I l �l Jl J
RECEIVE®
Building Permit Application DEC 2 9 2016
Planning and Development Services
Building and Code Regulation Division Lucie
PEWITTING
L
5t. Lucie
2300 Virginia Avenue,Fort Pierce FL 34982 Coty, F
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: y t r
Address: 7 937 Off✓ 404 `Ant • Or-f �7. fiU���� 3 yqJ 2
Legal Description: 3y Z5 — 7(9&— 0217 — O0 o !�
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
o b
_771
CONSTRUCTION INFORMATION:
Additional work toe nertormed under this permit—check all appy:
❑HVAC 0 Gas Tank F_]Gas Piping _Shutters ❑Wi dows/Doors
❑Electric ❑ Plumbing Sprinklers Generator _Roof ?'�2 Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 60q 4S . Utilities:cnSewer 0Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name KA l;9ah Name: r �
Address: 9 /lea A//5W& L.a"G Company: yWrSloA COn_ylYvyhDK
IT
City: -f ��: LGGi C ' " ' State: Address: 3•/.TO 0&7mery%af per. Ao k
Zip Code: 3 yJ SZ Fax: AI City: /jlejk4we� Q State: 1•/I
Phone No. 77 0 2 - 73 - 0154 Zip Code: St 91/0 _ Fa/x-: tip(O- W S'7933
E-Mail: 411A Phone No. &
I� J��" Z — 781
Fill in fee simple Title Holder on next page(if different E-Mail: it h01iO� .1LOrt. Co/J,sfi'�/GfjDN
from the Owner listed above) State or County License: CGL 13,30 7857
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.