HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMP« iD FOR APPLICATION TO BE ACCEPTED
Date: o�'/f%'/�? SCANNED Permit Number:
BY
µ�- St. Lucie County RECEIVED
Building Permit Application FES 10 2016
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 1-� Residential
PERMIT APPLICATION FOR:
Address: /z> 3 a / /e- _ ,, �� �� fly Lu r i 1, 'CL
,
Legal Description: -1-21ie% - -sro 1/702 — po p -
Property Tax ID #:
Lot No.
Site Plan Name: .e*m, 4_D7n //o� Block No.
Project Name: e—�xpi„: 22b//o-✓
Setbacks Front Back: Right Side: Left Side:
CONSTRWCTION;INFORMATI0N
Address: /z> 3 a / /e- _ ,, �� �� fly Lu r i 1, 'CL
,
Legal Description: -1-21ie% - -sro 1/702 — po p -
Property Tax ID #:
Lot No.
Site Plan Name: .e*m, 4_D7n //o� Block No.
Project Name: e—�xpi„: 22b//o-✓
Setbacks Front Back: Right Side: Left Side:
CONSTRWCTION;INFORMATI0N
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moneTwor to be performed underth
is permittTi a ii
tat app y:
Mechanical _Gas Tank
_Gas Piping
_Shutters
_Windows/Doors
_ Electric _ Plumbing
_ Sprinklers
_ Generator
_ Roof .I ; j✓
Total Sq. Ft of Construction:
Cost of Construction: $ ;>,?X 7-
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/,LESSEE:;; ,
&CONTRACTOR.=
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Name L/a77� 21c��
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Name: .G ✓
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Address: 7�e r'
Company: ;Oeix7�,'
City: oT. Q.
Zip Code: 371%� Fax:
Phone No.
State:i�
Address:_ /Dx/esj
e i C
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City: ��_a (.Y�cU
Zip Code: 7) Z. f (0
Phone No�7.-2---'S.C��
State
Fax: _7j3 —d1 —9 Sl3
— �2�L,7
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail [,',r�� J %r . r
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State or County License it
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If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. 00
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Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
AGE COMPANY: _ Not Applicable
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
Zip: Phone:
_Not Applicable
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
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Sign ure of Owner/ Lesse{on ractor as Agent for Owner
Signature of Contracto icense Holder
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STATE OF FLORIDA
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Type of I nti i ati n
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Personally Known OR Produced Identification
Type of Identific 'onc
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Commission (Seal)
Commission No. (Seal)
REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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