HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL A PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED a
Dater ����'�® Permit Number:
BY RECEIVED
s r - i - S�,1. ude count
Building Permit Application JUL 6 2015
Plan. fng and Development Services ST. Lucie County, Permitting
Bull � g and Code Regulation Division
23001 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential ?�
PER
11 IT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
i
PRO�OSED
IMPROVEMENT LOCATION:
Addr er��s: \% N2 �S `66y�1
Legal, II escription: NVC
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PropelIty Tax ID #: �A��- Qk - \' % G- `(�M' S) Lot No.\%Ilzky
Site P I n Name:.TC �� S _ Sr�4 Block No.
Proje Name:
Setb I�Cks Front Back: Right Side: Left Side:
,DETAILED ILED DESCRIPTION OF WORK:
;.CO ,STRUCTION INFORMATION:
ona work to e e orme under this permit - c ec a apply:
HVAC U_ Gas Tank ❑Gas Piping _ Shutters Windows/Doors
its
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total' Sq. Ft of Construction:
i
Cost . iIf
Construction: $ Lk 013
S Ft. of First Floor: _
Utilities: Sewer El Septic
Building Height:
-,01N 4ER/LESSEE:
CONTRACTOR:
Nam'i.
Addr'Iss:�3�'�
City:
Zip C
Name: "A VzA 9-so
Company: %1R3z CSJdS� =
Addrecss�:`1`y �„1 �Sh
City: State
State:
�de: 3kk,9L SFax:
Phone
E-M Ilil:
No. b y \ �b'
Zip Code:Mt(ZCb Fax:
Phone
�,a 7.�.
fee simple Title Holder on next page ( if different
!the Owner listed above)
Fill in'
from
E-Mail: is
State or County License:
If valJ,;e of construction is $2500 or more, a RECORDED Notice of Commencement is required.
C,
.SUP
LEMENTAL CONSTRUCTION LIEN' LAW.INFORMATION
DESI,
Nam
Add
City:
Zip:
NER/ENGINEER: Not Applicable
OQ C @�re.'Z.:c �_
MORTGAGE COMPANY: Not Applicable
Name:
Address:
ss:
Stater
2 Phone 'IkbS.!Ala . c,�
City: State:
Zip: Phone:
FEE §JMPLE
Nam
Add
City:
Zip:
TITLE HOLDER: _ Not Applicable
l
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
ess:
'I Phone:
it
Zip: Phone:
OWN R/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I cer i IIi� that no work or installation has commenced prior to the issuance of a permit.
St. Luc i' County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which § in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
struct ire. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In cong,deration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accckdance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The fo lowing building permit applications are exempt from undergoing a full concurrency review: room additions,
accessr structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WAR, ING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
impr ements to your property. A Notice of Commencement must be recorded and posted on the jobsite
befog' the first inspection. If you intend to obtain financing, consult with lender or an attorney before
com encing work or recording vour Notice of Commencement.
Sign
" ure of O ner Lessee/Contr as Agent for Owner
I
S' ature of Contractor/License Holder
STATE
OF FLORIDA
STATE OF FLORIDA
CO
OF 7JPt
COUNTY OF Sh
The
INTY
rgoing instrument was acknowledge before me
acknowledged -
�v1+
The �rgoing instr`ur�en`was acknowledgedvb�fore me
& day �� 20 %' by
this
•
3day of 20
I
I
this of
Name of person making statement
Name of person Taking statement
Pers
nally Known ✓OR Produced Identification
Personally Known OR Produced Identification
Typ
of Identification
Type of Identification
Pro'
iced
I
Produced
(Sig'
of Notary Public- State of Florida)
(Signature of Not ry Public- State of Florida )
Corrmission
Iature
No.
Commission No. ; `1�ar P ,.STELLI %49NTER
,``avP'•, STELLA M. HUNTER
:'?*• "`�; Notary Public -State of Florida
° • �= tary Public - State of Florida
-• Commission # FF 180552
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