HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST Bt 1 IPLETED FOR APPLICATION TO BE ACCEI`-
Date: SC BNNEU Permit Number: to ®tU' 0117
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} = St. Lucie Counti-
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= 1P ®Building Permit Application ��0��®
Planning and Development Services JUN Q _6 2016
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 PERMITTING
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ResideifflAucie county. FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line 11I
Address: —
Legal Description: SOl
Property Tax ID#: CA-UO - —
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: LeftSide:
Lot No..
Block No.
dooIt to (Ifc e7(4x
U V S ,1.u1,1t \238�7 'F- �Z38$
,CONS TRUCTtON,,lR�FQRM4TION
rtwna wor to e e orme - uncl6r this permit -check a . apply:
❑HVAC GasTankas Piping Shutters ® ^�0.
oors
Electric Plumbing Sprinklers Generator ® Roof
Total Sq. Ft of Construction:
Cost of Construction: $ :700d Q
S Ft. of First Floor: _
Utilities: Sewer ®Septic
Building Height:
OWNERJLESSEE
CONTRA`CTQR
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Name-5C)y� StI60 v (,g f f N!+.Ato tssoc . dNe.
Name: i+ Z
Address: ��71D/cc�2dolr4 r3rriB•
Company 1 C r.,,PP G�►��t
City; orf.ST LucaE State: Fc
Aildres's Ln�l
City' SL s state: FL
Zip Code: .75YFf0 Fax: 179-33Lc-14(Q9s
Phone No, FI%- S73'/soiy �w
Zip Code: 3S/gS3 Fax:
Phone Not770).--,>%0- r/F4
E-Mail: !» cam_ k.rce -w�rr-
Fill In fee simple Title Holder on next page (if different
E-Mail: Aa/o iv-4 v &zaxo 0. Cok,,n
State or County License:
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER.
_ Not Applicable
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MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: Applicable
Name:
_Not
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 permit wiil'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 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
_ Signature
STATE OF FLORIDA STATE OF FLORIDA
COUNTY 01 c . Lu r COUNTY OF
The forgoing instrument was acknowledged before me The forgoing inst umenIt was ackrf ledged.befgre me
thiss n day of _ I m� 20 �by this cL day of 20 1 � by
(Name of person acknowledging) (Name f person acknowledging)-
(Signature of Notary Public- State of Fior' ) (Signature of Notary Public- State of Florida )
Personally Known OR Produced Iden iflcatId
ion Personally Known OR Produ entification
Type of Identification Produced �L L_ Type of Identification Produced.L• �•L
Commission No.l-Fqq0_15 i
Revised 07/15/2014
KA'REN S. MUM
Commission # FF 1.15
June 12
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION .
SEATURTLE
MANGROVE
COUNTER -
REVIEW
REVIEW
REV W
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
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