HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
JAN Z 4 2017*
Building Permit Application
PERMITTING
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
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 qb
pRUPOSED 11111PROVEMEIT LO;CATIC}N
Address: 23 L.Av. iSTrPr ftc 101
Legal Description: Isrpr ST WG 23 tie,17" 0 40: /O�
Property Tax ID#: 3y2t _rGb— 03h5 "Day ' Lot No.
Site Plan Name: I�-19Block No.
Project Name:
Setbacks Front N q— Back: Right Side: N Left Side:
pETAILEDDESCtPTIaF WR ,.
C�r1� rSvti•2�,-v1 �/6o il.1/�ff ExP�
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CONSTFtUCTMFORMATION �
Additional work to be erformed under this permit-check all appy:
HVAC Gas Tank Gas Piping _Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ (70o Utilities:0_Sewer OSeptic Building Height:
rO1NNEM IL8 EE e t CONTRAGfiOR ;:
Name Name: MLC44ML /
Address: o I Company: I-71
City: G! State: Address:
Zip Code: 49 T-0 Fax: City: State:
Phone No. G732 Zip Code: Fax: cf Z—0C3t a
E-Mail: Phone No._/�^7 ,^/91,0
Fill in fee simple Title Holder on next page(if different E-Mail: CO Y 41161aD.e.
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTT ALCQNSTRUCTIQN LIEN LAW INFQRMATION '
K. - .. __' ...,-•, r._N >.a>>,.., -" :�.', ..p...e' ._ +.y s.< F>� .a.,...�. it^'-'.'.1.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Cliyio (V�sS Name:
Address: 112 C.)LO'MAn0 Address:
City: WI Stater City: State:
Zip: Phone: —lol 0—loZip: 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 pool fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your ail Record a Notice of Commencement m esult in your paying twice for
improvem o your pro er 1-e of Commencement must be r r I a sted on the jo site
beforethe first ns ctio . If o i e to obtain financing, consult t nde n attorney b o e
com encin w or r . or otice of Commencement.
� s
Signature Owner/Lessee/Contr as Agent for Owner Signature o (cense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF- COUNTY OF I_UK'/,r=
The forgot instrument was acknowledged before me The forgoiiy Instrument was acknowledged before me
this y of 94J 20/ by this/?`aa`y of r�J 20/__by
(Name of person acknowledging) (Name of person acknowledging)
(Signatu f Notary Public--State of Florida) (Sign atu reZiffiotary Public-State of F o�iTa)
Personally Known V OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. GAUMOND Commission No. (Seal)
- 1i
MY COMMISSION#FF 1ublic73907 :, ;fir ANN M.GAUMOND
EXPIRES;DeGe :. MY COM ISSIO
%;pf t\°•`.•` Bonded Thru Notary PUnderwriters :o EXPIRES:December 7,2018
a.
Revised 07/15/201
of 1�°•` Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS