HomeMy WebLinkAboutBuilding Permit Application IP
ALL APPLICABLE INFO MUST BE CON FLETED FOR APPLICATION TO BE ACCEPTS
Date: Permit Number:.
Lausill
Building Permit Application FEB 0 4• 2017
Planning and Development Services IaERMITTING
Building and Code Regulation Division St: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 lineF-lera�:7P
PROPOSED.IMPROVEMENT'LOCATION:
Address: q COe A rf _Sf C.0
Legal Description: i✓ {iTa hi kof(a f' /lY/ 0
�3�53-/�o<v
Property Tax ID#: a 6/C) Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
[CONSTRUCTION INFORMATION:
Additional work to be nerformedunder t is permit-check all apply:
❑HVAC Gas Tank [:]Gas Piping Shutters Windows/Doors
OElectric Plumbing OSprinklers []Generator �R_Roof
Total Sq. Ft of Construction: 1`7-7-7 S . Ft. of First Floor:
W �
Cost of Construction: $ �� Utilities: Sewer _Septic Building Height: /ai
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OWN ERAESSE CONTRACTOR:;
Name of e-I'WeS Name:
Address: �?()_7?j (�tYl-f 21��i'CC,Q Company: f� M '
City: State:Pt Address:,33((l SF ;S&� !Sf :I
j Zip Code:_5ggQ7 Fax: City: fr�kt- Stater_
Phone No. `1`7-3 q76I (OColO-12 Zip Code: �3IQgI Fax�7�7� G/
E-Mail: Phone No..-772 2 c29- -7-No:j
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) State or County License: CCC (3�CoS-7C(
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State: i
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applica bile
Name: Name:
Address: Address:
City: City: II
Zip: Phone: Zip: Phone:
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I certify that no work or installation has commenced prior to the issuance of a permit.
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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. 1
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 ford
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.
X lXJ ll.;L_ vc Q� & � s
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_Signature of Owner/Lessee gent J Sig re of n actor/License Holder
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STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFl,[ i`�d� COUNTY OF AM r-FI n !
The forgoing instrugient was acknowledged before me The forgoing instrument was acknowledged before me
this 87-7 day of O-Ail d(L 20 aby this I day of TFbV'UQL ►Z 20 I-7 by
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c ICI ara �Cr�(e�/ erc.Qr nC
(Name of person acknowledgi ) (Name of p son acknowledging)
"_ -U, 0,
:.- LRL6=4=,�
(Sign a re of Notary Public-StAt of lorida ) (Sign att re of Notary Public-ka o lorida )
°®�auweauoo,,�
Personally Known OR Produced Identification Personally Known k OR P�� j n
Type of Identification Produced �►�o Type of Identification Producecf+`� P Mission
_ SEC jq ✓i�� q '� � O
Commission No.,[�FSI(3�, .a4a" Commission No. ®(Se
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�'Ff87�3gS c :
:gig EE87�® �'AGeI/°h;�t stogy;�:���0`�`.�••
Revised 07/15/201499�.0��°Oghisrsr�Bs:�'. '����Z/hrneeT
REVIEWS FRONT ZOk1'R 1111t1�9ePERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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