HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABL''EE1 INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: Inc) I f
1)59
'-
RECEIVED
Building Permit Application JAN 10 2017
Planning and Development Services
Building and Code Regulation Division PERN11TTINGSt. 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
PROPOSED IMPROVEMENT LOCATION:
Address: 5-I O 3 PAC-►ti+ �A-we, r-on.? Pl eo-G l=
Legal Description: lryol Ari �tt/ C51,4 rclS " Uri 1-r fl-K 5r< 1-0 22
Property Tax ID#: JYQZ�0 / 0/26000 1 Lot No. '2-
Site Plan Name: Block No. S�
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION.:
Additional work toe performed under this permit-check all appy:
0 HVAC M Gas Tank E]Gas Piping _Shutters Q Windows/Doors
Electric El Plumbing Sprinklers E]Generator Roof l- Roof pitch
Total Sq. Ft of Construction: :2e S . Ft.of First Floor:
Cost of Construction:$ 2,300,--" Utilities: _Sewer Septic Building Height:
OWNER/LESSEE: '/ CONTRACTOR:
Name 812 tA, 1 29 L1 G I< Name: %'-YL- Aek,,Ara KaeuG1`'
Address: 5 l'j0 e4t,r",. -r)&IV t' Company:
City: r,)&T 1'1 Grl. L1� State:�L Address: S_Yd3 Pr4twl- O,2
Zip Code: Fax: City: Fo'krr /016/LC' r State: ISL
Phone No. C(9-7 -707 qC-z-1 Zip Code: TUM Fax:
E-Mail: h( i(An1ysotAf( ern�251ji; ")5 bit Phone No. 07 '707 W-Z,l
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: ,t 41\ Name:
Address: IN Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address: �1
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 thepermit 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. 41
s
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of ntractor/License Hold
STATE OF FLORID I 1 STATE F FLORIDA
COUNTY OF oe,,2 COU OF s4 L Ct�
The forgoing instrument was acknowledge before me T forgoing instryment as acknowledged befor me
this day of J 0,� 20 by this iy day of J 20 I )
lin �rbI i &
(Name of person acknowledging) (Name of pe on acknowledging)
(Signature of Notary Public-State of Florida) (Sig ature of Notary Public- tate of Florida)
Personally Known OR Produced Identificatio P rsonally Known OR PrgAu`ced I eatification
Type of Identification Produced Type of Identification roduced
Commission No. U / /U Se I�ACLYN DAWSON PRE gv ission No.
i AG �y oG �rYIN DAWSO RE ]da
Notary Public,State of lorida mPublic, ate of FI C mrnissien#EE 87,W4
Revised 07/15/2014 My comm.expires Feb.04,2017 My comm. pires Feb.04,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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