HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONram,
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ALL APPLICABLE INFO MUST BE COMPLETED FOR _APPLICATION TO BE ACCEPTED
Date: 1 1 0' NO SCANNED Permit Number:'000
St. Lu e County RECEIVED
WON
Building Permit Application MAR 10 2016
Planning and Development Services
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie County, FL
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
Legal
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
work -✓ ,f'rp o p—
# SCw 0 1140 Po' tz '8
CONSTRUCTION INFORMATION:
Additional work to e e orme under t-checkispermit a apply:
0HVAC be
E]GasPiping In Shutters []Windows/Doors
Electric Plumbing []Sprinklers E] Generator ®aw V,'7"C�
Total Sq. Ft of Construction: ' 00 L- V S Ft. of First Floor: _
Cost of Construction: $ Utilities Sewer ElSeptic
Building Height:
OWNER/LESS-EE:
CONTRACTOR:
Name
!
Name: Jbe4ael AlderWtra.
Address: w
Company: ve ws s ;.
City:_Srjux:IF
Zip Code: Fax:
Phone No. 1'I
State:9.
01 No
ii2
Address: Z/OG-C .51-1 evm�ft:� 4VC
City: PSL State: FL
ZipCode:3y4S3 Fax:77L-e9R-loop
Phone No. 772 -10P-
E-Mail:
Fill In fee simple Title Holder on next page (if different
from the Owner listed above) -
E-Mail: a Jc(;e, a /�ernc..@ ed.caw
State or County License: C6 .6 yfS63
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONST_ RUCTION LIEN LAW INFORMATION:
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:
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
_ Signature of Owner/ Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORID ,A \ I STATE OF FLORIp/�
COUNTY OF )! ��c-G COUNTY OF % '/r Gu C� I.
The for oing instrument as acknowledged before me The fo oing instrument was acknowledged ..,efore me
thisday of� 20 �by this dayof M�dC� 20=by
�Ic^•I�fN' Y� ' �j�� /r' /1'lf�(✓lZlri/t-!V
(Name of person acknowledging) (Name of person acknowledging)
&P C4�3= L4L Id --
(Signature of Notary Public- State of Florida) (Signature of Notary Public- State of Florida )
Personally Known
Type of Identification
Commission
August 12,
Revised 07/15/2014
Personally Known
+meof Identification Prodh
Produced Identification
O
IRK ARI KATZ
MISSION #FFne.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
IIO i
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COMPLETE
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INITIALS
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