HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE CON rED FOR APPLICATION TO BE ACCEPTED''
Date: G G /Lo y SCANNED Permit Number: Am6'La • �/
BY
y St. Lucie Coijot
Building Permit Application RECEIIVEM
Planning and Development Services
Building and Code Regulation Division JUN / 6 2016
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial i Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
Address: i23Lb— i
Legal Description:
Property Tax ID
Site Plan Name:
Project'Name:
Setbacks Front Back: Right Side:
Left Side:
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Lot No.
Block No.
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❑HVAC -EJGas Tank as,Piping Shutters IVY oors
Electric Plumbing ®Sprinklers Generator Roof
Total Sq. Ft of Constructioy to I S Ft. of First Floor:
Cost of Construction: $ 1,900 .-®0 r 'vyUtilities:SewerE]Septic Building Height:
-OWNER%LESSEE`
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CONTRACTOR
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Name
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Address: /drooz� �yyLgu�t-r[d/iriay�.
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City: Poi i s'r L.'c c
State:%__ ''`Address
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Zip Code: 3 tfSSU Fax:
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'City ' T.'__ �F
State:_rQ_
Phone No. 77 �i- 973- GOl 4
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Zip Code:--*? r/,9.S_3
Phone No. U7--.,) 3 70 -
Fax: U !r
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E-Mail: G�•Lu%5 - ere%L. Ce— .
Fill in fee simple Title Holder on next page (if different
E-Mail: d:2
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State or County License:
from the Owner listed above)
It value of construction is 52590 or more, a RECORDED Notice of Commencement is required.
Name: _
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ il"Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: ✓ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
Zip: Phone:
Applicable
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 miy 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 conaurrency 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
commege g wbfk or recording vour Notice of Commenrpmanf_
{..YrTlml n*l
ASSo by-)
_ Signature
STATE OF FLORIDA
COUNTY OF 7nj . WC A-e_
The fo oing instrument was acknowledged before me
this" day of 20 IAby
(Name of person acknowledging)
C
(Signature of Notary Public- State of FlotAa )
Personally Known OR Produced Identification
Type of identification Produced FL Dj
Commission Nol L—q4Q,5�{ ( NF6tHrn u�oonu
Revised 07/15/2014
Signat a of Contractor/License Holder
STATE OF FLb9lDA
COUNTYOF
The forgoing inst ument was acknowledged before me
this�dayof UitF 20 W_by
MU i Lrnl��
(Name'df person acknowledging)
n „L
of Notary Public- State
Personally Known OR Produced Identification
Type of Identification Produced
KAREN S,.NIEL,S
018.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER .
REVIEW
REVIEW
REV)EW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS