HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /`/�
Date: -�� a'� SCANNED Permit Number: I LoLJ�
BY ..a
44
"- St. Lucie Count%
• "°'0' Esc 51 .ten
Building Permit Application FEB -1 1016
Planning and Development Services
Public Works
Building and Code Regulation Division St. Lucie
nty, F
L
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select fro m`d%opb xoxo Ic ick arrow`s tt he MY-4 A A eFDCks-V-----'
Address:
Legal Description:
Property Tax ID #: 3S 3 S- 603 — 0116 "- 9 Lot No.
Site Plan Name:
Project Name:
Setbacks Fr
Back: Right Side: Left Side:
P
Block No.
Gas Tank
❑Gas
Piping
Shutters
❑
Windows/Doors.
I'tPlumbing
Sprinklers
Generator
11
Roof
Total Sq. Ft of Const ton- 1�17!!,c�/2�y" S Ft. of First Floor: _
Cost ofConstructi .b0� tad L•. 13 Utilities. �Sewer�Septic
Building Height:
OWNER/LESSEE
CONTRACTORy
' Fs
Name
Name: mAtleFZ
Company: r'�
�Z
Address:
City:
Zip Code: Fax:
Phone No. - 6
E-Mail: A1110 A?G 024d
State: E/
Addres
City:l,tde
Zip Code: Fax:
Phone No.
State:44—=7/
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: c�T)M¢
C• C&I
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPOLEMENTALCONSTRUCTION LIEN LAW INFORMATION'
" � - ^=-
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City: State:
Zip: Phone:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
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 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 organ attorney before
_ Signature of Owner/ressee/Agent Signature of C6RiraW/License Holder
STATE OF FLORIDA ATE OF FLORIDA
COUNTY OF ST. L V C 1 I_ COUNTY OF UC i F_
The forgoing instrument was acknowledged before me
this I dayof 2UAR IPKOby
€o�'2ey VAf.�e>2�
(Name of person acknowledging)
Sa
(Signature of Nota Public- State of Florida )
Personally Known _
Type of Identification
Commission
Revised 07/15/2014
OR Produced
rCCO LEEN KAHANII
MY RMISSION #FF006!
EXPIRES April 10, 2017
The forgoing instrument was acknowledged before me
this If dayof gg 2 tt 20 (_#by
Ail LOPE %Gel .f12l �
(Na of person acknowledging )
� 21'r
(Signature of Notary Public tate of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
My COMMISSION
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COM =
INIAALD