HomeMy WebLinkAboutBUILDING PERMIT APPLICATION-ALL APPLICABLE INFO MUST BET % ,dPLETED FOR APPLICATION TO BE ACCEI' + --- _ . .
Date: v, SCANNED r.� PermitNumbepV(D - OII py
110- St. LucieCount% RECEIVE®
.BY
Buglding Permit Applicatb a
Planning and Development Services JUN 0 6 2016,
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue, Fort Pierce FL 34982 st. Lucie county, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, dick arrow at the end of line III
Address:1, St
Legal Description:
Property Tax ID #: LkEzlp- 80-1
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side:
Left Side:
Lot No.
Block.No.
�eplAcI� GAra9P Dt�� f ik[° <or Il`kP L6x7 F
12390 , 12392 , 123 94. , I 2:-:!),c'j6
bmsTRkiCTlON'INFORK4AT{OWv .
ACIClitional work to e e orme under ispermit -c ec a apply:
®HVAC be
as Piping Shutters �Winde*iyY/Doors
®Electric � Plumbing hspririkters ® Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ •3000o0 Utilities.
cnSewer ®Septic Building Height:
0 4TiVERf LESSEE:.°
, CCINTRA OR:
Name 5a.>F s FlI ,9g50c.
Name: pie n i
Address: 13(oQonvw asnuc At✓D. a?`p'"
City: J2anSl laca,E State;: �G "Address
Zip Code: 3 ct ` 9 O Fax:1-Ia-33Lo-
Phone No. 3 - &0tf
peZ
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city Y
Zip Code y9S3 Fax: Al
Phone No. 7 - /%
State: Ft
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E-Mail: cL• Lw`�c pll�Yee .off.
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: r ba ,ia
00. GO r�
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State or Rouw License: a BSV
3
ea,a�v wnau moon a pcouu or more, a.Kr.LVKUCU Notice or commencement is required.
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: ✓ Not Applicable
Name:
Address: `
City:
Zip: Phone:
MORTGAGE COMPANY: ✓ Not Applicable
Name:
Address:
City: ' State:
Zip: Phone:
BONDING COMPANY: ✓Not Applicable
Name:
Address:
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 will authorize the •permit holder to build the subject structure
which is in conflict with any applicable Home Ownars 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.
I
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
/ CvMm.m�
( Assoc 1a S
_ Signature of OwAerl Lessee/Agent
' Signa a of Cohtract4rJLicense Holder
STATE OF FLORIDA , - STATE OF FLORIDA - ICI .
COUNTY OF IAC I Q- COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisj_( dayof 20 4by this,;—dayof 20 Ila-by
(Name of person acknowledging) (Na�f person acknowledging r,
(Signature of Notary Public- State of FI r a) (Signature of Notary Public- State of Florida)
Personally Known OR Produ ed Identification Personally Known OR Produce identification &✓
Type of identification Produced -L Zi(: Type of -Identification Produced i. C J.
Commission No.
cols n No.
°,°
HEATHERHAR
MYCOMMiSSON
FFs47534'
;6ap,,
KAREN S. NI,ELSEN
-
24 0'
= e
c'
Commission a FF 115637
-
��- B.&dR1NftVPMkUnd9WbM
y UOMMISSIon Expires
Revised07/15/201$
June 12, 2018
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