HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABL INFO MUST BE COM,"ED FOR APPLICATION TO BE ACCEPTED
Date: 1� z SCANNED Permit Number: 1
BY
St. Lucie County a
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
- 7 2016
PR
Building Permit Application A„works
St. Lucie County FL
Commercial Residential
_PERMIT APPLICATION FOR: }�rppet luode15
PROP -D IN ROUfMENT LOCAtTI r N:
Address:
Legal Des
FMFWZ
Property Tax ID #: 3y1S- SD l - OD65- 030- 3 Lot No.:_
Site Plan Name: A11A Block No. V
Project
S1,
Setbacks Front Back: Right Side: Left Side:
_Mechanical _Gas Tank _Gas Piping
_ Electric Plumbing Sprinklers
_ Shutters
Generator
Windows/Doors
Roof
XI3
Total Sq. Ft of Construction: A.mai. 3W 5%e+ Sq. Ft, of First Floor: 6o:6: Z 19V
Cost of Construction: $ 9&019 Utilities: _Sewer _Septic Building Height: ) %OP
W E /LE E :
CONTRACTOR:
Name I Ll G .. /W `e Dw-Ff [(a2)
Name
Address: .034 NW Miller pr;✓P
�
Compan
A B. e
City: Ri7rf" St, Apcie State:
Address: -?fit"5� • Lrow�rn/
�lr✓P
City: 11A cl{ :.s . I /zeuI e-
State:
Zip Code: 3W 3 Fax:
Phone No. ?7i-g6O-a33J'
Zip Code: `3yg�Q3 Fax:
Phone No '77.�- O
795;a
E-Mail:
Fill in fee simple Title Holder on next page (if different -
E-Mail
Kayia e/rLe3/
State or County License C6C/,4a19
// c�c/ya id
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
ilL
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 such
prohibit
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
commencingwork or recordingour Notice of Commencement.
ev.
SUFPL
DESIGNER/ENGINEER:
Name: d Nceai !jr
_Not Applicable
MORTGAGE COMPANY:
Name:
_Not pplicable
Address:
Address:
City: State:
Zip: Phone 77a�631-5909
City:
Zip: Phone:
State:
FEE SIMPLE TITLE H LDER:
Name:
_ of Applicable
BONDING COMPAN
Name:
of Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Signature of Owner/ ee/A nt
Signature of Co cto icense Holder
STATE OF FLORIDA j '
STATE OF FLORIDA
COUNTY OF L
COUNTY OF
The�oing instrume was knowledgQdlaefore me
this day of 20
The forgoing instrument was acknowledged before me
this day of 20_ by
y
(Name of person acknowledging)
(=16—
(Signature of Notar P blic- State of Florida) (Signature of Nota