HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPL'G, �J FOR APPLICATION TO BE ACCEPTED Date: CaO pa1 \�0 Permit Number: W OG- 01;; L1 14
RECEI`.'"D JUN 3 0 2016 6(;HNNED
Building Permit Application BY
Planning and Development Services St. Lucie County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Y
'Phone: (772) 462-1553 Fax: (772) 462-1578 COrnrnercial T Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line S� a n_ Wq III
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
V
Property Tax ID tt:
Site Plan Name:
Project Name: _
Setbacks Front Back: Right Side:
I -N , 1 I rNr \\, ,, 11
Left Side:
DETAILED DESCRIPTION OF WORK: I�I
<CONSTRUCTION INFORMATION:
Mona wor to e e orme under this permit.— check a apply:
❑HW �GasTank ❑Gas Piping _Shutters ❑Windows/Doors
❑_ Electric ,5O Plumbing gam, Sprinklers E Generator Roof
ota Sq. Ft f Cons ction: S Ft. of First Floor:
rr�� �
Cost of Construction: $ ODQD O Utilities: Sewer ❑ Septic Building Height: _
-..OWNER ESSEE: ; '`
CONTRACTOR:
Name
Name: 2
oo
Address.$ 9 , 6/. G
G
Company: \ O ^_,co; .
City: �42� .be -Aou � State:'
Zip Code: 3y 9 Jr a Fax:
Phone No.
Address: \\
City: Q •`erte State:
Zip Code: TAC0-A b Fax:h°_t�9L_q bkl -a\<'l
Phone No. MD '� �y - �`� 1 %
E-Mail:
Fill.in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License: ! Cp00 \c; 1
]?value of construction is,SZ5nn or more, a RECORDED Notice of Commencement is required.
SUPPLEMEN
NSTRUCTI
EN LAW INFORMATION:
DESIGNER/ GIN
Name:
_
SLY"
Not Applicable
ec
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: U? air
Address:
City: �ra \\
Zip: O'1r13\
Phone: q' l —c,9
State:7: Na
b— 991S
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _
Name:
Not Applicable
BONDING COMPANY: _Not Applicable
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 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 failure to Record a Notice of Commencement may result in your paying twice for
improvements to yourproperty. 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
commencing work or recording vour Notice of Commencement.
_Sig }ure of Owner/
STATE OF FLORID
COUNTY OF �eAg
The forgoing instr ment was acknowledged before me
thi90't day of 20 1 by
-k Ac.� L\' .
(Names of
perso knowledging )
(Signature of Notary Public -State of Florida )
Commission No. SwAL ji my dfie dbion FF 947863
Revised 07/15/2014
Signatu of Contractor/Licedse Holder
STATE OF FLORID► ,
COUNTY OFF L .
The forgoing instrument was acknowledged before me
th!GWy day of*'Vx.9 20 � by
(NanWof person acknowledging)
(Signature of Notary Public -State of Florida )
tonally , daptj%p '
Type of Identification Pro .e
:r Trade L Lamb
Commission No. My FF 947883
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