HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLCiiD FOR APPLICATION TO BE ACCEPTED
Date: k2. 111. 11 S' Permit Number:
4 SCANNED
BY
St. Lucie Countv DEC 11 2015
Building Permit Application
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:
,PROPOSED 'IMPROVEMENT, LOCATION:
Address: I
Legal Description:
,0100 -T 6
Property Tax ID #: W-5-1 / - -5 / 7- 00 Z I - 0 Lot No'
Site Plan Name: (5> 60 0 Q5 ce Block No.
Project Name: - 0 &- 71
Setbacks Front Back: Right Side: Left Side:
1' 0 EtAl LED' 15E`SC R'l PTI ONJ FWO,1116,
N:
—Mechanical _Gas Tank Gas Piping _Shutters
— Electric Plumbing _Sprinklers — Generator
Total Sq. Ft of Construction:
Cost of Construction: $ `§, oco�—
Sq. Ft. of First Floor: _
Utilities: —Sewer _Septic
XW i ndows/Doors
Roof
Building Height:
OR: --To R:
CONTRACT
Name 96eq,"
JA A
Name: ��A
Address: CdAi,S64"O:'t�Svd
"Acompan
City: n-eA SJ--4A e) eJDC-L /Statef-1,
Zip Code: _ 34 c!i S I Fax: TM,-VLS-
Phone No. I'M - 1;VV - 9 14,S
Address: 8S Se o,f-4
city:
Zip Code:-34q9
Phone No
Fax--772 Z�
WO/
E-Mail:
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.
SUPPLEIVIENTALCONSTRUCTIO,N LIENLAVV"INFORMATION,,
;..,.
DESIGNER/ENGINEER:
Name:
Address:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
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:
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
commencing work or recording vour Notice of Commencement.
c ���PJ"wi Cam, ✓J
Signature O Lessee/Agent
S' Contractor/License Holder
of er/
ture of
STATE OF. FLORID IA � �� G `�
of
ATE OF FLORIDA
Z C
COUNTY OF
COUNTY OF oc- ,
The fomping instr ent was acknowledged before me ~
�--Q�.�iw '
The f ing inst�ent was ayk 'edged be re me
this _j/_ day of . 20, by
this day asillwA Ohl . 20 / by
Name ff erson acknowledging)
(Name per acknowledging)
72
(
q S-
ignature of Notary Public- State of Florida)
/Signakure of Notary Public- State of Florida )
Personally Known X_ OR Produced Identification
Personally Prac Idwtiftcation
Type of Identification
Type of Id ti fik! p Notary Public State of Florida
Produced b8fai1L_
�y� 'Notary Po61ic Sim 0 on
�,i,Sa Greer Bharath
+��T1 �lazeoo (Seal)
. My Caminission EE 187800
or n Expires 02IOa12010
Commissio o Seal)
Expires 07J0a/2018
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SUPERVISOR
PLANS
VEGETATION
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MANGROVE
COUNTER
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DATE
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