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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE tumPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: /LoO'CD,(.or� 6l: BY RECEIVED 3t. Ludecounty AUG 1 2 2016 Building Permit Application Planning and Development Services PERMITTING i LuceCounty, Building and Code Regulation Division St. FL 2300 Virginia Avenue, Fort Pierce FL 34982 / Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential t/ PERMITAPPLICATION FOR: PR0.12ig INcPW-0 EMf-NT L©CATIO'N: Address: oiOOLend Legal Description: Property Tax ID #: 3W . (QOOD, - QC(, C009 Lot No. Site Plan Name: Project Name: Setbacks Front Back:3D - �kZ ght Side: r K--t1-ClAeM Left Side: CCDVerl' M _/Mechanical _ Gas Tank _ Gas Piping _Shutters _ Windows/Doors v_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Total Sq. Ft of Construction: ' 63 rY'1 G"`t7 Sq. Ft. of First Floor: 3(,[ Cost of Construction:$ /4#Z00.`9 Utilities: _Sewer _Septic Building Height: OW'' NE /LESSEE: C©NT ACTO Name a 0l1I Name: OWr-t AIAflc�2o� Address: IKL-C) S Le- Company: City: l'et(c Q State: FI( Zip Code: `1 `( -7 Fax: Phone No. 70 -Cl7 f-7 Address:'. City: State: — Zip Code: Fax: Phone No E-Mail: V-af L 44Of q (KOL, I CDOA Fill in fee simple Title Holder on next page ( if different . from the Owner listed above) E-Mail State or County License If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. 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 com ncin work or recordin our Notice of Commencement. ev. SUPPLEMiENTAL GONSTRiU.CTION IEN LAW INFQRMATION': DESIGNER/ENGINEER: Name: _Not Applicable MORTGAGE COMPANY: Name: Not Applicable Address: Address: City: Zip: Phone State: City: Zip: Phone: State: FEE SIMPLE TITLE HOLDER: Name: Not Applicable BONDING COMPANY: Name: _Not Applicable Address: Address: City: City: Zip: Phone: Zip: Phone: 1 Signature of 0 r/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTYOF COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me thislapp day lye a� . 20� by this _day of 20_ by ��of��la �IV�I`r,`t II,LQ (Name of person acknowledging) (Name of person acknowledging ) �(3'ig ature of Notary Public -Sate of Florida) (Signature of Notary. Public- State of Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced s M LASHAHNA INGRAM Produced b Notary Public -State of Florida Commission No. ` '� �� • My Coqge