HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED %
Date: ]� �)'J U SCANNED Permit Number:
r, s ��-E w. BY
St. Lucie County RECEIVED
Building Permit Application
Planning and Development Services APR 2 1 2016
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: To Select from dropbox, click arrow at the end of line III
PROPOSED IMPROVEMENT LOCATION:
Address: C142,5 P1Eace N7>_ ,49S)
Legal Description: Mown C CW.ari'W Cxv3— Vuij NNZCL- - 1`cz4 Z) 1�;
L-7,gz.A0 tOt✓ 1,1$-C603)
Property Tax ID#: 130L-1101000S000y Lot No.
Site Plan Name: "EPIPOA-'OPO 60 %-V P.» I Block No.
Project Name: C,,a ?-CR %-ALr=Me3 y
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF, WORK: o
� P�AcC
)ID 10tiJ
4>1e, CAo%-C-D
0141uirt. VirtJ4
C-P I L COU
6cz-"3
CONSTRUCTION INFORMATION:
�rTiT�t�nno umr to n nn nrmo iinflarthic nurmit—r—Fnrle nil that nnn p
-_I Gas Tank UGas Piping
0 Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ % 1 la , Q) O .O D
Shutters ❑Windows/Doors
Generator Roof
SqI FFtt.I of First Floor: _
Utilities: LJ Sewer 0 Septic
Building Height:
01NNER/LESSEE:
_1
CONTRACTOR:
Name MfcpOOvuep 60%5V
da6.0 G�Y3J (24- ,Q
Name:
Address: qlla-S 1110,wW"M
Company: 19-5CQ-DN `=NL
City: F'T P %kru.-
Zip Code: 3Ag15 Fax:
Phone No.� =7
State.
D
Address: 1 SS°t, SW a11si P-J"+u,
City: V1 • \ .P\apesLo.-k- State: F-L
Zip Code: 33312 Fax:
Phone No. e154 -9a3- I16S4
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License: 51 Pi E CAta=)3u13
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTttIiCTtONLIEN
I:AW'INFORMATION
N a RIM
DESIGNER/ENGINEER:
Name:
:�C Not Applicable
MORTGAGE COMPANY:
Name:
X_ Not Applicable
Address:
Address:
City:
ZIP: Phone:
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
X Not Applicable
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
which is in conFlicmiawith any applicable lHothat
e Owners Association' rules authorize
bylaws or the 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, 1 do hereby agree that 1 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
rnmmanri na.A,nA, ,.. .e......Ji.......-.." _c.-__.__
_ Signature of Owner/ Lesseel�llnt '
STATE OF FLORIDA
COUNTY OF
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Signature of or/License er
STATE OF FLORIDA
COUNTY OF
The forgg��mg in ment yva acknowledge{l before me The forgoing in ment s acknowledge before me
this'Z day of 201�P_by thi45--day f 20/l by
(Name of person acknowledging) (Name of person acknowledging)
n
-we..e
ry ruouc- xate-Qt&u rt iaT
(Signiliture of Notary Publi tate of Florda f O
Personally Known
Type of Identifica
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CINDY L
Notary Public •State of Florida
Personally Known OR Produced Identification
Type of Identifica o¢
--Miaxrait: LOPEZ
Commission No.
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Commis(gealr FF203556
MY Comm. Expires Mar 1.2019
1041
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Commission My COMMISq15ft41212977671
"• .• EXPIRES Apd1,03, 2020
norm
Revised 07/15/2014
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