HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE ' IPLETED FOR APPLICATION TO BE ACCE D j jj� bn
Date 5(;AIVNEU Permit Number.
BY
St. Lucie County RECE��ED
Building Permit Application
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
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
Property Tax ID #: L
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block, No,
DETAILED. DESCRIPTION OF WORK:
QP(I (a6 y Go��P D°0/s L1Ice .r1or I ; kP (px7 d 9�r7
caIbt aine-5 (mac: i1C 1239S — Q-4co
L=JHVAC L--1Gas Tank I lGas
®Electric 0 Plumbing Spr
Total Sq. Ft of Construction:
Cost of Construction: $ D - 610
Piping
tiers LJ Generator
S Ft. of First Floor: _
Utilities: Sewer OSeptic
�..
Building Height:
OWNER/LESSEE:,
CONTRACTOR:
Name eSsoc, Z e-
Name: 1 LBLeo
Address: 1'1(9 oa I n ourM ✓tF/Jti�t 8 t✓D.: = = :.Company=-/i=
= o/
City: Iw2( S %- L .GGL Stater
Zip Code: 3N9SU Fax: -)ia-3H(o-I oq�.:..Cityc:�,..�:.�'-_.1P.L_!:
Phone No. 7175' (ooFF wv—"
q
Address "'�St7 S c/ /rl ([j �[; v� /Y✓P
_ (
State:-E—L
-Zip Code: Fax: A'/fj
Phone No. ft j
'
(Mail:_-
Fill in fee simple Title Holder on neat page ( if different
from the Owner listed above)
E-Mail: gWy 1*ryr,
�Yazoo.
State or County License: _-ad3 Y3
it value or conscrucnon is >zouu or more, a KECUKOEo Notice of Commencement is required.
^, EN.IAtiiV ITUFORMATIQN ` i
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City: _
Zip:
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 bulld 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 afull 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
ibmmu:+ �
_ Signature of Ownd'r/ Lessee/Agent
STATE OF FLORIDA STATEOF FLORIDA '
COUNTYOF UJL_O_, COUNTY OF
The fp oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this , L! day of l� 20 Wby this � day of'4;/C I EE 20 14, by
i2:n l e 1 M t'l•i L�,arz
(Name of person acknowledging) (NaWe of person acknowled ing )_
of Notary
Personally Known OR Pro�ced Irlen cation
Type of Identification Produced �L li
Commission No. E- t
Revised 07/15/2014
(Signature of Notary Public- State
Personally Known OR Produced Identification
Type of Identification Produced
KAREN S.
Commission
...n,ssion explr®§
June 72, 2010
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REV W
REVIEW
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REVIEW
DATE
NO 4
COMPLETE
INITIALS
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