HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPI D FOR APPLICATION TO BE ACCEPTED
Date: oZ / L�:> Permit Number:
ISoa c) 3 q1
SCANNtL,
BY
Building Permit Application St. Luce Count„
Planning and Development Services
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:
Address: 3(Z
Legal Description: _% ifE Sl�RO� r T/�K ^ P�{iQ V 1
Property Tax ID #: / 2iCiPP2 Lot No.
Site Plan Name: 1 Block No.
Project Name: 4A-e s ail S
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: k
.5
_Mechanical
Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ / ty 0, 0
Gas Piping
Sprinklers
—Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof
Utilities: _Sewer _Septic Building Height:
9WNER/LESSEE: ;
CONTRACTOR:
Name odijCC Y6ec
e: JP, IotacG ew
N I
Address:.. 3Zl.Z tAfLa 10W IQ
Cotpany: Aidgae-t SGe
�4,-f
City: FT OrE(�c= State:EL—
` Zip Code: 3 01 qj Fax:
Phone No. `% i Z' 705 ` 20lS
Address: xC Z4 - 'Ul "e t Ik --.
City: aj; Lt �� `` �
Zip Code: 3�f9yc�' Fax:
Phone No. `TT7Z' Z/5 ' O&Z7
State: L
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: S 1 L6 f 60
r D I .
Sat or County License:,. �? (_
I 1 - aka
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPF?LEMENTAI. GONSTRu
Lei+ a°
N LIEh LAW INFORMATION`
:.. &4 a+St` A{. y s " t .(. ':+& rt'__ S.
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone:
ate:
City:
Zip: Phone:
i State:
/
FEE SIMPLE TITLE HOLDER:
Name:
_ N Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:
City:
!
City:
Zip: Phone! /
Zip: Pho
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit tho 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 ['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'anil 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 vour Notice of Commencement.
Signature if Ow`ner/Agent/ Lessee ., „
Signature of Contr or/License Holder
STATE OF FLORIpA
COUNTY OF LQ
STATE OF FLORIDA
G L1
I.L(Q
COUNTY OF L.L�i
The for oing instrum nt was acknowledged before me
7
The forgoing instruwent was acknowledged before me
� 1
this day of J�LL P 20J6 by
—T
this day of G6bttt-" .26[6 by
1
aVA `)cry 1 I P-76
(Name of person acknowledging)
`, ro
(Name of p son acknowledging)
r7;(�� �/l IClll
t ature of Notary Public- S e of Florida)
(Sig t e of Notary Public -State of Florida )
✓/
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification roduced
Type of Identification Produced pY o
Opp0.Y. py&C LORRAINE SORTING
Commission No. • pN#EE219680
' ' •.••
Commission No. •s, + CO S.'AuMt24,2016
,MYCO
EXPIRES: August 24, 2016
�''Eor
S:August24,2016
ornoa° Bonded Ttuu Budget NrAyy Semces
noa° Bonded Thm Budget Notary Services
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ZONING
SUPERVISOR
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MANGROVE
COUNTER
REVIEW_
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EDATE
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