HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONV
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ✓J 77
Date: / . IN /' 4 SCANNED Permit Number: /& L9(•y 4Os_
BY
St. Lucie County
Building Permit Application JUL e 7 2016
Planning and Development Services
Building and Code Regulation Division
2300VirginiaAvenue, 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 Ill
Address:
Legal Description:
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PropertyTax lD#: ��cS-1Pc��T ���i.N'�. Lot No.
Site Plan Name: .� 1 �J n C1�r es Block No.
Project Name: � -1a✓) D Gums
Setbacks Front Back: Right Sider Left Side:
(Sene J'WepaliiS A) Oam"Loa- 2eolq Cab Cali-, S
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��HVAC jGasTank �Ga:
&ectric ❑:P,lumbing []Spi
Total Sq. Ft of Construction:
Cost of Construction: $ 19 1
Piping " Shutters
Generator
S Ft. of First Floor:
Utilities: Sewer Septic
QWindows/Doors
Imo. Roof
Building Height:
Name
Name:
Address- $ LYL,
Company:
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City: S eac j,,� l State: _
Zip Code: �nFax.
Phone No.(9- cV 7- N I'S
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Address:
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City: ' leal)
Zip Code: 15 1
Phone No.
State:
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Fax; �4R
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E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
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E-Mail:OKPI i-fl o Lau
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State or County Licensje-:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. / ? ar�
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SEIPPCIQN(piALCt)I4STR
JCTIO�i LIEN LAi�t lA1FQIiMATiOt�i� f �
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone:
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE H DER:
Name:
_ Not Applicable
BONDING COMPA :
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 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
commencing work or recording vour Notice of Commencement. r,
_ Signature of
STATE OF F-I
COUNTY OF
STATE OF FLORIDA/
COUNTY OF �/U�%f n, aQ AWV _ �c'-LU
The forgoing instrument was acknowledged before me The for ing instrum nt was acknowledged before me
this,R7 day of /v 20 &by this /d(ayof 20 /, by
1 jl/VTA/7NR/ cL7G/err) ao
(Name of person acknowledging ) �V (Nam erson acknowledging )
(signature or Notary rur
Personally Kn
Type of Identirl
Commission N
Revised 07/15/2014
State of Florida )pp (Sign' #rt f Not ry �P Irc�- State of Florida)
iKpfpl7L TNenFt7flc9r� Personally Known `' OR Produced Identification
egO Type of Identification Produced
.(PIKES. ®Muary
)ybr%=):'" Commission No. (Seal)
4;1.1.'sti . IUANA C CURRY
EXPIRES May 07.2019
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SUPERVISOR
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INITIALS