HomeMy WebLinkAboutBUILDING PERMIT APPLICATION,,
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED tl
Date: C.P 1-\\\ IrD Permit Number:
RECEI'.'-D JUN 09 2016
SCANNED
Building Permit Application BY
Planning and Development Services St. Lucie Counh'
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ( Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Cpd d as
PRnPOSFD IMPROVFMFNT I nf=ATInN
Address: ('D2X>0 S' aGE� 1,>/'&l✓i= �r'7�oD-f7JSEA. I�EJ�L-�'
Legal Description: A-rLA N-n,; Ir 'N "fHE z/i fin. rt io3 4 0 & eA -Xl
1., '^MMr,nl Z2e Aa.r-r- /^,l /6/'7_#4/791 ."16 10%4. ?GL2—/7e
Property Tax ID ti: yc4- S/3 — QJc/fv -00C)— 5--
Site Plan Name: 41/MLL
Project Name: KG/A-or
Setbacks Front N A, Back: 4A_ Right Side: N A Left Side: NA
Lot No.
Block No.
L DETAILED DESGRIPTION•OF WORK: III
13-9 " o F NEInJ�6w" aA/45
y2" i4uw,k I Co26 (Paic&4oDI W A&"4n J"
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CONSTRUCTION -INFORMATION `
Additional work to be nertormed under tis permit —chec all that apply:
OHVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers E Generator g Roof
Total Sq. Ft of Construction:
m
Cost of Construction: $ % r0
S Ft. of First Floor: _
Utilities: Sewer ElSeptic
Building Height;
OWNER/LESSEE - . -:
CONTRACTOR:
Name 6DWR► 3 F K/L.fbt A
Name: W kc U+4t1_ (00DOW r^)
Address: Si'1
Company: _3f3ytCN fg.Ar,4 &mk".Alu�
City: 5wkyyr State:
Zip Code: ?J"( CIoIL Fax:
Phone No. ri27J� ��Z P/
Address:
City: f3wA-ni State: FL.
Zip Code: 3,4114 ItFax: 6 !p 2. G'/ %yy
Phone No. (0 001-1D
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: /G
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
—if
SURP.LEMENTAL CONSTRUCTION UEN-LAW
INFORM
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone:
State:
City:
Zip: Phone:
State: _
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 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 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 ure to Record a Notice of Commencement may result in your Plying twice for
improvements to your $ o Y. A Notice of Commencement must be recor d a post o he jobsit
befor fjfht irySpec fo you intend to obtain financing, c ult ith I de r itf or y before
co en u4� w.�rk odre din¢ intend
Notice of Con mencert�nt. / // /
_ Signature of
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ,3 Z l9G/,r_ I COUNTY OF ST UC/�
The forgging instrument was acknowledged before me The for ing instrument was acknowledged before me
this- BY of �UA�� 20/�by thi4 ay of 20 /�_ by
�i/C�7air/�G �✓lX�i�i,7if� %%,�Cf/�iE� �'s�/`6%L�1/9J
(Name of person acknowledging) (Name of person acknowledging )
(Signature o�fNotary Public- State of Florida) (Signature-of-N'otary Public -State of Florida )
Personally Known tl'� OR Produced Identification Personally Known r/ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.
MY COMMISSION 8 FF 173907
Banded TWu Notary Pull¢ Undenmters
Revised 07/
Commission No,
ANN M.
December?
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