HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABL INFJ
(MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 0a k2
Date: Q t Permit Number: p
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Building Permit Application FEB - 9 2016
Planning and Development Services Pubiit k/VdH;.§
St. L_uc&o Cowiiy, f'L
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
PROPOSED IMPROVEMENT LOCATION:
Address: -Noy —l._. �SQ S
Le al Description:LA 1, AP/_- �,��;�9 �.x�- P I•
Property Tax ID#: ( ��1�1- (rI5 -j;1 1 I" ` �L� Lot No.
Site Plan Name: �{` Block No.
Project Name:�-d M � E!S 3F4t
Setbacks Front Back: Right Side: Left Side:
IDETAILED DESCRIPTION OF WORK:
Fvl ���5 - -E%r-T�_tc ; %-6�k-t� �iiUo I �"�N�apG� , ZEti�tiol c,
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CONSTRUCTION INFORMATION:
�itjiona wor to e e orme under this permit-check a apply:
KHVAC Gas Tank ❑Gas Piping _Shutters a Windows/Doors
INElectric 0 Plumbing O Sprinklers E]Generator F]Roof Roof pitch
Total Sq.Ft of Construction: ZI IJ S .Ft.of First Floor:
Cost of Construction:$ oUOOCL�®� Utilities. _Sewer P Septic Building Height:
OWNER/LESSEE: CONTRACT R:
Name ) a 6T�:3 Name:
Address: _= 6c_> o- Company: 1 vi, D U
City: ET 17�r�(t.C. State: L(_ Address: 33 �>Ukt i�(ZISE.
Zip Code: '1u�l��l Fax: City: eee'F State:
Phone No. Zip Code: 3`Ijq T Fax:
E-Mail: c�tc. � _ s4ol - . Phone No. ?-IF
Fill in fee simple Titie Holder on next page(if different E-Mail: 6
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: Name:
Address: �To �� ��/- Address:
City: F r P,�. State: 9;6/J 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 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.
s
Sig ature of Owner L ee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA // 11 J STATE OF FLORIDA f '
COUNTY OF � L� 3 � COUNTY OF
The oin instr n as acknowled before me The forgoing instru nt was acknowledged before me
this�day of . 20 y this a day of �4 20 J__�by
(Name of person acknowledging) (Name of person acknowledging)
DA\,�A 6-Vy�
(Signature of Not Public-State of Florida) (Signature of I
ary Public-State of Florida)
Personally Known OR Pro Ide i ation PersonallyKnown OR Pro (dent f do V
Type of Identification Produced ��, Type of Identification Produced /
Commissio IYo�••1'YP ANGELA"If Commission No. (Seal)
Notary Public State of Florida
3•; :•2 Commission# FF 234730 `.�PpY P;;a,,, ANGELA M HUFF
My Comm.Expires May 27,2019" �2; °
Revised /1 �, �4 Bonded through National Notary Assn. N* y Commission#FF 234730
OF FI°p My Comm.Expires May 27,2019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE •��
INITIALS �•
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