HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Li 1N 1, \6 SCANNED Per it'Number: I GO 4 >OI `� a
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St. Lu e i outtFiy D APR 11 1016 RECEIVED
Building Permit Application ApR y t 2016
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 D< Residential
PERMIT APPLICATION FOR: "''"'�
To Select from dropbox, click arrow at the end of line Q ,.,,,e, -Ill.. III
Address:
Legal Description:�`Z�'30 LAC) All �:4bnE S� p�t�Fa..j AJ 6P
Lt.%-e �-e 4y8r-Cd—d yyn>r A S I -� P5� ;D GALS
Property Tax ID #: S!A ra-7-1 (� 0 00 _rTy1-C4;- Lot No.
Site Plan Name:
Project Name: �kc'" L'GUl PS
Setbacks Front Back: Right Side: Left Side:
Block No.
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CONSTRUCTIONINF,ORMAIT,11 :
Additional work to be nertormed under tispermit-check a appy:
11HVAC Gas Tank Gas Piping _Shutters ❑ Windows/Doors
Electric 0 Plumbing []Sprinklers 0 Generator Roof
Total Sq. Ft of Construction: I5 , 000 9 . P+ • S Ft. of First Floor:
uctio Cost ofConstrn:$ 1C9I (-I�D•Ltl Utilities: _SewerOSeptic Building Height:
O'U1/NER/LESSEE
C~ONTR°A,CTiORv
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Name �l�l LnnR t3W\&L\. G C-ncp
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Addres�CX� s: S ( S --I,C)LA -
Company:
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Zip Code: FLjtj r Fax:
Phone No. a3s- 3 (��
Address:
city: t-, _State:Tt�a
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Zip Code: �nM �P 1 Fax:
Phone No. U ��
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E-Mail: 91h6i 9OWAeA'-
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
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E-Mail: - -y1 11YVl C Y t7LrLRi%L. C _�,
State or County License: - orG
„ va,ue ur cunstrucnon is pzouu or more, a newnueu notice or commencement is required.
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SPIR 1EMENT ALGONSTRU IIOIV LIE LAW INFgORM4TION =5,`{�
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DESIGNERLENf�INEER:
e: Nam _ a Qn;'d,l iAG1rtP01
_ Not Applicable
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MORTGAGE COMPANY: _
Name:
Not Applicable
Address: IS
6:V-10— 1J
Address:
City: P_�
Zip: �--Aoe c) Phone: _ �,L4--7
State: _L—
94— tP% I
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not
Name:
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 or an attorney before
commencing work or recording vour Notice of Commencement. '
Au. D v `— 5
_ Signature of Owne Lessee77�g_ent Signature of Contractor/License Holder
STATE OF FLO� �� /) — STATE OF FLORI
COUNTY OF t�-6l� COUNTY OF �Z51,3 1X r
The o instrum twos ac owledge afore m�/sue"••, Thef instrum�qtw'as acknowledge fore me
this da f�, 20og MY CCU ,�(� , this ay of `pbl�lti�( , 20 by
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(Name of pe n acknowledgin °.�� 09 '� a ; ��IVame o erg cknowledging)
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ture of Notary Public- at ary of orida".1' r Fi01ilt3 t,�*��??�' (Sig ure of Nc u lic-5 qua
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Personally Known OR Produced Identification Personally Known � OR Prodbacl, t atones
Type of Identification Produce _ Type of Identification Produced �=rnP°=
Commission No. (Seal) Commission No.
Revised 07/15/2014
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