HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE C
Date: I. ))�) )„
FOR APPLICATION TO BE
SCANNED
BY
St. Lucie Countv
Planning and'Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
$-60q -DOln
Project Name:
Setbacks Front Back:
Permit Number: /40 0 /- D'?
1 - 9VED
Building Permit Application
JUL 14 2016
Commercial Residential
Right Side: Left Side:
N 7eL n 1, E, s@
Lot No.
Block No.
dr i5' foo e lV e��rb l g 5, 1
Additional .work to De perrormea under mis permit -cnecK an -mat apply:
_Mechanical ' _ Gas Tank _ Gas Piping _ ?Shutters t_ Windows/Doors
Electric _ Plumbing _Sprinklers `11 ' 1 itGenerator of
Total Sq. F`tof Construction: ! Sq. Ft. of First Floor:
I
Cost of Construction: $ 1)5bo Utilities: _Sewer _Septic Building Height: i
OW N'EAtLESE EE:
CONTRACTOR:
Name t:w, e!<c b
Name: 1,1 S�en<x
Address: o10o3 O\E axi2 I' `` t%
Company: qtiX-L
City: " -,erg State: (
Zip Code: 3LkgG Fax:
Phone No.�.-ti16 21ao
Address: ClLtO -'>1145W
City: or�
Zip Code: 5��> (
Phone jVo
Stater
Fax:
E-Mail: 1to-^a 44,ck"c� qjC 4u41'el.(n v,
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail 51Aeti (oxc 8
f �,
State or County License L6 C - C>S-) 35:�-
If value of construction Is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENT L CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_•NoYApplicable
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:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Countyy 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
improv ments to your property. A Notice of Commencement must be recorded and posted on the jobsite
before he first inspection. If you intend to obtain financin consult with lender or an attorney before
comme cin work or recordingour Notice of Commencement.
ev.
TO t2
7/2014
s o The forgoing ins ent was acknowledged
Signatu f Owner/ Lessee/Contractor as Agent for
��
Signat e f Contractor/License Holder
.y=„„—,:
STATE F FLORID
STATE OF FLORIDA
.
COON OF
COUNTY OF
The for oing instr ent was acknowledge�J before
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