HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLE': .�z; FOR APPLICATION TO BE ACCEPTED
Date: a, °� �jG Permit Number: \ 6 O a- (3\6 )
7�Rll4r. RECEIVED FEB 091016 SCANNED
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
BY
Building Permit Application St. Lucie County
Commercial , Residential
PERMIT APPLICATION FOR: Corn, t% � A
Address:
Legal Description:
Property TaxID#: /�S`fL`7`7UI—IOdiV`�i(XJ/�
Site Plan Name: G
Project Name: cl &/C4 A1 r�iZ21�--
Setbacks Front Back: Right Side: Left Side:
x-Mechanical _IGas 'Tank _Gas Piping _Shutters
,)�_ Electric ZT[umbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: 116S SF Sq. Ft. of First Floor:
OF
Cost of Construction: $log Utilities: Sewer peptic
Lot No.��
Block No.
Windows/Doors
Roof
Building Height:
OsWNERjLESSEE "#°r�.-xt;�
CQI�ITRAC7OR . `�'.4, kg
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Name lylawk 4 ro A tn 1c
Name: uH
el
Address: 10Company:
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City: Pa ct y�, u.rr r State: ja
Zip Code: QSZ. Fax:
Phone No. %7
Address: /JO 7— 5
City: T d
Zip Code: Fax:
Phone No 77Z 3
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State*F'
E-Mail: Mu
Fill in fee simple Title Holder on next page ( if different'
from the Owner listed above)
fO�
E-Mailer
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
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 yo"tend to obta��'nn financing, consult with lender'or attorn before
rommpnrine wnrk nr mcordint{u6ur Notice �Commen cement. - //
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Signature of Owner/ Lessee/Agent ISignaturollofCo-ntractoF/Licensebt6ider
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Sk_ 1. Oc \
COUNTY OF i
The forgoing instrument was acknowledged before me
0\
The forgoing instrument was acknowledged befo "e me
q day lk� 20-N& by
this day of 20 \9 by
this of ,
``
4% AA
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary blic- State of Florida)
Signature of Notary . ,blic- State of Florida )
Personally Known OR Prody¢ed f enffifiB� ow1__-
PtleFxp, es oe a5a�g1
Type of Identificationl� ; e
ersonally Known _.a-�O'R Piodub€Pf 1QPe �yionda
a of Identi i �afion••'_d ' arc Nota y PObExP es Dec 16, 2p1
n " Notary
Produced ri L- gEE
s¢il duced Q �• Comm #EE 5505
F+I— .""= Gomm
`f: ! � . • _ y co00'__NaCoaa\Notary
to-' Sbm�9
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Commission No. roe piled Thtou9 National Nolacy Assn.
Commission No. L'Q�. e,
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW,
REV] W
RE E
REVIEW
-REVIEW
REVIEW
DATE
RECEIVED
1_
!
DATE
rQ
COMPLETED
Rev.7/2014 /