HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLe rrJ FOR APPLICATIO)kTO BE ACCEPTED
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Date: -'I (' � (� Permit Number:
RECEI`•77D MW 111016
SCANNED
Building Permit Application BY
C i Luce County
Planning and Development Services St. y
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Commercial 4e Residential
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line C (3 m
PROPOSED IMPROVEMENT LOCATION:
Address: U 5 • �— e�! �Q�
Legal Description: F'4I cl -S-v5 nb") C7(7J1i
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PropertyTax ID #: (Q J�� Lot No.
Site Plan Name: LI (L{ c+ c do key e-�K d Block No.
If J i rrer- 5,-( C "'ri J-.r %�- 8 ti e 4-"
Project Name: U5 144o
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
itiona wor to e e orme under tispermit—c ec a apply:
❑HVAC M_ Gas Tank ❑Gas Piping _ Shutters Windows/Doors
Electric El Plumbing Sprinklers Generator Roof
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Total Sq. Ft of Construction: WoAs b(7 e-K S Ft. of First Floor: U l 51 Y (,
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Cost of Construction: $ 1- (,0c40UJ Utilities: _ Sewer 1-1Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name r t P S c
Name: f�cllc iho� cis
Tom
Address:
Company:
City: State: _
Address: /tea ✓���
City: State.
Zip Code: Fax:
Phone No.
Zip Code: -1=i `fS Fax:
E-Mail:
Phone No.
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the Owner listed above)
State or County License: C rSr
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. y
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DESIGNER/ NGI jE : _ Not Applicable' —
.Name: �Y�1 �s0C--
AIL
'MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State.
City: State:
Zip: L Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _'f4ot Applicable
Name:
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 our Notice of Commencement.
Signature of n essee/Contractor 218&ej4Jor Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF. s'�
STATE OF FLORIDA
COUNTY OF
The forgoing instru�mme�Aqt was acknowledge before me
this __C1 of d 'd i 20� by
The for of g instrum nt was acknowledged before me
this "Vday of 21101 by
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(Name acknowledging)
(Name of person ackn )edging )
(ofperson
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(Signature, mot ry Public -St of Florida)
(Signature of Notary Public -Slat of Florida
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificatioh ABC
Type of Identificatiort
Produced x aFF_
V1F0 'ECI Fr 24,p1B
Commission 4, ~ • MaG1 eal)
Produced
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Commission f ;«"� CAS 24 6eal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETDCfION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
RVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
L
DATE71f-
COMPLETED
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