HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE,INFO MUST BE COMPLEz,._�FOR APPLICATION TO BE ACCEPTED
Date:�'I�1 _ Permit Number: Q`+EGEI@/F®Q�
SCANNED
BY JAN 1 1 2016
. , St. Lucie Comb
- PERtAITTING
-- ------ -- - Building Permit ApplicationSt. Lucie County, FL
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:
Legal Description:
Property Tax ID #: ► 3U 1 —�oC� � `dZ �3 ' (D (36- z Lot No. �i•S
Site Plan Name: Block No.
Project Name:
1-1
Setbacks Front Back: Right Side: Left Side:
_Mechanical _ Gas Tank _ Gas Piping _Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: 1q (oq Sq
Cost of Construction: $ l g iJ Jam, Utilities:
_ Generator_ Roof
Ft. of First Floor: ( 4 oI
_Sewer _Septic BuildingHeight:�
OWNER/LE=S-SEE:
CONTRACTOR:
....:.....
Name C;-WA" eG2.:vth;o 7;
T
Name:
Address: !op '7 ! ii� '�' r
Company:, -
City: Stated/
Zip Code: Q9S/ Fax: ►2/:o
Phone No. t1-7Z-S79 90v ?g
q�
Address: '--_ 35�/.. Saaitlsc� D(—
City: �l� /State:��
FLW ee
Zip Code: 3 Y^Z �� Fax: 17
Phone No �s 3SS
E-Mail:
Fill in fee si ple Title Holder on next page ( if different
from the Owner listed above)
E-Mail,/ lVb, ca 1,tae. .-vEr
G
State or County License
t
If value of construction is 2500 or more, a RECORDED Notice of Commencement is reguirea.
SUPPLEMENTAL CONST
ION LIEN
W
NFORMATION.
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_Not Applicable
BONDING COMPANY: - of Applicable
Name:
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.
LP
Signature of Owner/ Lessee/Agent
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S'tLuGE
COUNTY OF S�. L�LtP,
The for$oing instru eht was acknowledged before me
The forgoing instrument was acknowledged before me
this/c/ dayof F—(C&MbqA- 20/S by
this dayof J)eCCmber ,20J5 by
217-F-%r 14, 0AA)1') 01 J
Lo 2 i w I ► � l,p MS'
of person acknowledging)
(Name of person acknowledging)
/(Name
—7� —
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known is OR Produced Identification
Personally Known " OR, ProducedIdentification
Type of Identification
Type of Identification
pic ' ItYN G DRAVWY `
Produced
Produced
PATRICIA A. STANTON
Y COMMISSION 0 FF198558
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