HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number: LOS-0&Y7
BY
St. LucieCounty RECEIVED
Building Permit Application uA
Planning and Development services MAY 2 2 2015
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: To Select from dropbox, click arrow at the end of line III
illliin^CrM Mfin0r%%ICRAEKIT 1 11C ATI AIV ..
Address: /v /
Legal Description:
Property Tax ID#: Y V—,- 91
Site Plan Name: 29 1a
Project Name: 444
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
gw
Lot No.
Block No.
CONSTRUCTION INFORMATION:
ltiona wor to e e orme under t—checkispermit
a
apply:. .
�HVAC MGasTank
FlGasPiping_Shutters
❑Windows/Doors
Electric F J Plumbing
❑Sprinklers
Generator
El Roof
Total Sq. Ft of Construction: .00
50.
Ft. of First Floor:
Cost of Construction:$495SD•aCT Utilities:
Sewer El Septic
Building Height:&
OWNER/LESSEE: 4
CO.NTRACT R:
Nam inn
Name:
Address:
City:;4 Stater-
Zip Code;, �R 5 Fax:
Phone No. .r 7 2
Company:
t�
Address:3 a4f
5
City: 1
Zip Code."2//
phone No. a Cv
State:'
Fax: /5
—eq 7/1
E-Mail:
FIII in fee simple Title Holder on next page ( If different
from the Owner listed above)
E-Mail;QC'., iU 5
i�GC�atcl�� 1�
State or County Licenseyf 35y
/&!7
It value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEME
CONSTRUCTION
LIEN LAW INFORMATION:
DESIGNE NGIN
Name:
ER:
-
Not Applicable
MORTGAGE COMPANY:
Name:
_Not Applicable
Address: 28—
yr,2A0
Address:
City:
Zip
Phone: -S8
State:
- i
City:
Zip: Phone:
State: _
FEE SIMPLE TITLEHOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip:
Phone:
Zip: Phone:
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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Assoclation rules, bylaws or anscovenants 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
_ Si ature of Owner/ Lessee/Agent
STATE OF FLORIDA �• p
COUNTY OF ,h
The fcygoin nstr ment was acknowledged before me
thi da of 20IS-by
(NaFi@ of person acknowledging )
(Signature of Notary Public- State of Florida )
OR Produced
Commission No. + NOW&WAGStateofFlorida
r Trade L Lamb
-?orptr Expires
Revised 07/15/2014
Signature of r
ntractor/License Holder
STATE OF FLORIDA �- o
COUNTY OF
The fgrgoing instrument was acknowledged before me
this +day of M 20 by
(Name of pe s n acknowledging )
(Signature of Notary Public- State of Florida )
Commission
OR Produced Identification
Produced.
Expires
L Lamb
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
S
INITIALS
Q