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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 p Date: [a_ 11:�. 1( 0 G Permit Number: RECEIVED .,�,a.�.,...�... ........ Building Permit Application DEC 0 5 2016 Planning and Development Services t_ 1� PERMITTING Building and Code Regulation Division G 6 1 St. Lucie County, FL 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: Address: I D g5 / S, OC64A.' 0/Z- Sc;� Legal Description: 12e-12 Property Tax ID #: Site Plan Name: 4151 ' �-10- ©©ems -- 000 - o Project Name: Setbacks Front Back: r Right Side: X/ / ditional work to be pertormea unaertnis permit -cnec _Mechanical — Gas Tank _ Gas Piping Electric — Plumbing — Sprinklers Total Sq. Ft of Construction: v"01 Cost of Construction: $ Left Side: Lot No. Block No. all that apply: _ Shutters — Windows/Doors — Generator — Roof Sq. Ft. of First Floor: Utilities: —Sewer —Septic Building Height: Name yvIA2TlG� $r_a_16,vC?- Address: 1 O k V S OCc"�-� )Q't City: Sc ^' S C'v c? State: P' L Zip Code: 3tiQi--5'7 Fax: Phone No. %18 3 89 79 66 E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) Name: COLUN &L gHt:,✓ 7Z Company: FdLluc C101.-0-11 4&XA/�'Cr1,2i Address: 31M AICS stlyc,ltic' U'L City: TC,`' Sc-- 0C As 14 Stater Zip Code: 3Nc S7 Fax: Phone No E-b0' GI%1-SL)G1 E-Mail State or County License G ac 1U. 0 63y if value of construction is 2500 or more, a RECORDED Notice of Commencement is requires. DESIGNER/ENGINEER: _ Not Applicable Name: MiiP filk&) r'VA%'V Cn"/ 6 Address: S 31 50 D1'c I t? 1.1w5/ City: STv > State: ,Ec_ Zip: 3LU110t 6 Phone 772 2Y7 o92.S FEE SIMPLE TITLE HOLDER: .v Not Applicable MORTGAGE COMPANY: Name: Address: Citv: Zip: Phone: BONDING COMPANY: Name: Name:_ Address: - Address: City: City:_ Zip: Phone: Zip: Phone: _LLNot Applicable State: Not Applicable OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated. 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 qX recording our Notice of Commencement. Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF ST GvC I L C COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this S� day of fyzL , 201b by this day of , 20_ by C 0 L 1Il un4' , 4 1+\.l (Name of person acknowle ging) r M (Name of person acknowledging) (Sign ture of Notary Public- State of Florida) (Signature of Notary Public- State of Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification T e of Identification ```, p' '4 Produced """" ,, KAREN S. W L @ ce +° °= Commission S FF My Commission Commission No. ��'��o�I�°. 115637 E�PT�mjS on No. Seal ,m%�„a June 12, 2 18 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE ` COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 7/2014