HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,1
Date: 46 � 9 � 15 Permit Number: 1 S6� -a04 a
r RECEI%'ED AUG 04 2015
SCANNED
Building Permit Application BY
Planning and Development Services St. Lucie County
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 GoM '6 u 114 III
I:1C111111190RUN7
Address:
Legal Description:
Property Tax ID #/: - 3
Site Plan Name: 'T & %-
Project Name: .5
ENT LOCATION:
_S4-
Setbacks Front Back:
I & U fa-2.'D Fri
Right Side: Left Side:
Lot No.
_ Block No.
DETAILED DESCRIPTION OF WORK:
� NS I 'IHlS2,51 A-1 v it it 4 u r t FM-S 'PO I fs peFL T L. *b J V &-
C-DO
CONSTRUCTION INFORMATION:
Add_itiona wor to e e orme under tispermit-check all apply:
11HVAC Gas Tank ❑Gas Piping _ Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers 0 Generator El Roof
Total Sq. Ft of Construction: Sqq����Ft.II of First Floor:
Cost of Construction: $ 4': 4017 ' 05 Lltilities: LJ Sewer ElSeptic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameVC-1 A 11I I I C A
Name:
P
\wvo
Address:9140NIn1 Q--e-Scryr (x1rk
Company: H011-t O
k Ci`(lSAruCfIQn InC•
City: �p6r+ 'SOl It 11iC11' State: FL
Zip Code: 349RD Fax:1-12- 4{n-1- (121
Phone No. -Y12 - 41 e"1 - IyO,_')
Address: 26OIt4W `'�ed
0O_WI cCi.*V It
City: QM •
Zip Code: _& 1
Phone No. �1 2�+- q�J�-
State:
Fax:954- 95-1 -�
Q_i�PZ
E-Mail �1QQTcr (11
Fill in fee simple Title Holder on next page (if differef
from the Owner listed above)
E-Mail:
C
State or unty License:
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If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
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 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 or recording our Notice of Commencement.
s
_ Signature o er L ssee nt Sig ture of ntracto icense Holder
STATE OF FLORI S ATE OF FLO A
COUNTY OF V. L 12, COUNTY OF � FnVA/CAI�J
The forng instrument was acknowledged before me
this�dayof 1u\H 20 J.Sby
\,
(Name of person acknowledging )
(Signature of Nota6ubric- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
Revised 07/15/2014
The forgoing instrument was acknowledged before me
this s?5 day of��_, 20 L by
n &Znn ply )"hj
(Name of person acknowledging )
of *tary Public -State of Florida )
�i
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.y `�� (Sea()
W C011tMI&Joii EE144276
Expires 11/07/2015
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