HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE u 4TED FOR APPLICATION TO.BE ACCEPTI -
Date: g �i • LO SCANNED Permit Number: I i0 O L • 0 / l l il.
BY
St. Lucie Countv
Building Permit Application RECEIVED
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue -Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
JUN / 6 2016
Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
Legal Description:
Property Tax ID
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
-a
Lot No.
Block No.
RyIacti�5 "p ajvo/S loe-e A, like tox7 Q1-
GwC QT7 1�i-A �235g -f 123�
❑HVAC LiGasTank
Electric Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $;_ 900 . 0 U
is Piping
appiy:
Shutters Doors
Generator Roof
S Ft. of First Floor: _
UtilitiesSewer ®Septic
Building Height:
A Fa v r�
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4e„�At�';M
Name ,-
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Address: (a6Cro _�rtnowti4LcyC 9(Llt9. `
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Company ��R
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City: 17oR-t ST 1. Vr_ State:
ZipCode:___3_SSC�_ Fax:�IIa 33[v-)4C
Phone No. 77-2-- 873—(cost{
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tater
Zip Code: zs/9S Fax:
Phone No.
E-Mail: cU --(
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: AZ eo. coysi
State or County License: tl
if vaiue or construction is $25vo or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: "
Not Applicable
MORTGAGE COMPANY:
_ /ANot Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone:'
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
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 perrhit willlauthorize the'pernift 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 updeigoirig a full concuirency 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
Lessee/Agent
STATE OFF LORID�� STATE OF FLORIDA
COUNTY OF COUNTY OF v
The fo oing instrument was acknowledged before me The fo going instrument was acknowledged before me
this . day of 20 LW by this f day of �l i� a . 20 � by
Ian II1 D p
(Name �of�person
�acknowledging) (Nam f person acknowledging)'
c.,�-1=�-%rYcxnr✓ �-idt.�lU,Y_lA_�1t�7 ► �.
(Signature of Notary Public- State of FI da) (Signature of Notary Public- State of Florida }
Personally Known OR Produced Id,
ntfication Personally Known OR Produced Identification
Type of Identification Produced FL Bi_ Type of Identification Produced r(. (l • "
Commission No.
' 1'��"/tlJt� commiA HMNNG NVom fission No.— .-::.z -. Salk.
.: MY COMMISSION f FF
2. EXPIRES: Fahumv 9n20 KAREN. S. NLELSEN::
Revised 07/15/2014
My Commission£xpires
,June 12. 2018
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