HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO OUST BE COMrLt i ED FOR APPLICATION TO BE ACCEPTED "
Date: 7 Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description:
SCANNED
BY S
St. Lucie Coun S ' 4R 14 2016
Building Permit Applicatlon Public %,Vurks
St. Lucie CVnty, FL
Commercial Residential
!- fit...
Property Tax ID #: ! Lot No.
Site Plan Name: 4r cf1e.t4 PI ri Z�1� Block No.
Project Name:
Right Side: Left Side:
AUUMUndi WUIK LU ae llenUlmeu unuei ,`nin pcnnu— UIC�K du wdL dNNry. 4
11 •
+Mechanical _'Gas Tank ' �'`GasPiping _Shutters
Electric P1uynbing _Sprinklers _Generator
Total Sq. Ft of Construction: �� Sq. Ft. of First Floor:
Cost of Construction:$ Lo
Utilities: _Sewer -.-Septic
Roof
Building Height:
,CON,RAGOR OW-
a L'
h
`yy
Name AL a e or o th rr
Name:
Address:.Jam9 tW l
Company:
City: c,L r �e State:
Zip Code: �7 �C/ l� % Fax:
Phone No. 72 .Z
Address:
City: c 1 ?
Zip Code: ?,k((e Fax:
-�PhoneNo 2 U cl
State:
E-Mail: o tr�G.yloa buy /1,,-J;
Falco
Fill in fee simple Title Holder on next page (if differeht ..'
from the Owner listed above)
E-Mail7
W0l, L+✓l
State or County License -,4� .2 G
ci 3 j
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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
is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
which
structure. Please consult with your Home Owners Association and'review your deed for any restrictiohs 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 rion-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your payin twice for
improvements to your property. A Notice of Commencement must be recorded and post n the job '
before the first inspection. If you intend obtain fina g, consult with I er or an t rney befo
commencingwork or r cordin you otce of Co ncement.
eV.
�S"UPP,L�.t�NTAGON�ST,Rl�4;,•(�'��hTq�lAWOR
AT[�?"N� � '�k
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City: State:
Zip: Phone
City: '
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
c
Signature Own /Lessee gent
Signatup of C tracto r icense Holder
STATE OF FLORIDA //
STATE OF FLORIDA
COUNTY OF b'Yf•
COUNTY OF %F•
The forgoing instrument was acknowledged before me
this �day 1/n�G
The forgoing instru�e�n�t�was acknowledged before me
this�dayof /!U !� 20f� by
.20�pby
,
//ofj
(Name of person acknowledging)
(Name of person acknow
edgi )
(Signature of Notary Public- fate of Florida)
(Signature of Notary Public= State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifi tin
Type of Identifi on
Produced —
�
Produced � REN S. NIELSEN
Commission p FF 775637
Commission No. My [r9i eaj�ission Expires
Commission No.
_
o` ac KAREN($� hl
FEi S5sta7
ommiss a
My Commission Expires
June 12, 2018
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