HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONMLA nr U B 1 FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (� �Permit Number: 16 0 —�
SCANNED
Building Permit Application Ely
Planning and Development Services St. Lucie County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION
Address: 9,5 .3-')- 'z?•
Legal Description:
Property Tax ID #: 23 2- 7 Lot No.
Site Plan Name: Block No.
Project Name: CIV--S 7; / j/&d S
Setbacks Front_ Back: Right Side: Left Side:
DETAILED DESCRIPTION OF,WORK
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CONSTRUCTION INFORMATION::
itiona wor to e e orme un ert is perm -c ec a
apply:
1JHVAC E,GasTank ❑Gas Piping
LJ Shutters ❑Windows/Doors
11 Electric 0 Plumbing Sprinklers
El Generator 01 Roof
Total Sq. Ft of Construction:
Cost of Construction: $
S Ft. of First Floor. _
Utilities: Sewer n Septic
Building Height:
OWNER/LESSEE .',
CQNTRACTOR:
_
-'
Name I M C"
Name:
;
Address: �%� s/"' Lz1
�I
Company: /�' fv,-
<? 9r T�aio 5�
City: fbief gL--46,-1-e-Stat-:lam '
Zip Code: 345 S - Fax:
Phone No.:�7 roo
Address: (7 ( 3 &L%
O
City: 9 i I n !•-
Zip Code:
Phone No. �(�,
r { State:, 331
Fax:
J�6 2—
E-Mail: Ni t-liy
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: ilt%: YLS (9a069 A' f .fa6, 1z AAA%
State or County License: !�i OOM 3.$ y
it value of construction is SZ500 or more, a RECORDED Notice at Commencement is required.
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Name: — .... ..
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: —Not
Name: Applicable
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name: —
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Address:
Zip: Phone.
_.Not Applicable
I certify that no work or installation has commenced prior to the issuance of a permit.
which is n conriicmt With anrepresentation
app,, cab el nHome Owne stAssoclationrtrulesabylaws or anscovenants 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
commg90nQ work or recording your Notice of rnmmenrn.. __+
_Signature of Owner/ Lessee/Agent
STATE OF FLQ$�B/�
COUNTYo IJJ/t�/e
The forgoing instru nt was acknowledged before me
this IIb dayof /l 20kjb;
_MCh�,/l C�ltorr
(Name o�fperson acicnowledgtng )
A�
(Signature of N Public -state of Florida )
Personally Known N OR Produced Identification
Type of Identification Produrod
Commission
Revised 07/15/2014
REVIEWS I FRONT I ZONING
COUNTER REVIFW
INITIALS
EXPIRES:
STATE OF FLORIDA
COUNTYOF P�zPt �E//cr Cd
The forgoing instrument was acknowledged before me
this () day of f"% d �( 20 L by
IYf liICLlf�/t-o'rnsa(y
(Name of person acknowledging)
(Signature of Notary Public -State of Florida )
Personally Known OR Produced Identification
I'eofIdentificationProduced u A. LIcC-nfr
mission Nn_
'r rumor state of FIodda
Robert M Rice
Expires 04/03/2017
PLANS
SUPERVISOR
I REV I VREVIEWEGETATION I SEA TURTLREVIEW E I MRANGRO
EVIEWVE