HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APRLICATIU' N TO BE ACCEPTED %)
Date: 'S Permit Number: I6 0 F O (I -
s SCANNED
BY
'__• St. LucieCoun . RECEIVED
Building Pergit Application
Planning and Development Services AUG - 5 2016
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
�:PR[]PZJS�19 IMPROUEIVIENT LO�ATIONi" � , ,. n. .
Address: Zoo N /t!A 1,3/' 0G /V-- /2
Legal Description:
Property Tax ID#i: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Sider Left Side:
DETAILED DESCRjPT101V QF WO.RK env
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CONSTRUCTION,`I,IVFORMATION "' R
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0-HVAC ❑Gas Tank
11 Electric 0 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Piping ❑_Shutters ❑Windows/Doors
nklers ❑ Generator ❑ Roof
SFt .I of First Floor:
Utilities: LJSewer []Septic Building Height:
QWNERfLESSEE
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CONTRACTOR y
Name1!9-=5A.)
Name: G 0QhrA�7- S7—r`1 af�
Address: /.2 0 0 (3
Company:
City: 7-7- State:=L
Zip Code: Fax: 772 - 15 6.7-
No. �a -sip -,-.72,57
Address: P 0- /3-:9X �L C -� b
City: e itGe_e/>o /5 0B State: P
Zip Code: 31 `� 7-7 Fax: Q/3-g2�f-vorg
Phone No.
_Phone
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: STRUcr✓ 2ef-W q-4 x5:'fl 011.7
State or County License: G C�G 0 6 / 3 ..
If.value of construction is $2500 or more, a RECORDED Notice of Commencementis required.
S°IJPPLEIVI,ENTAL.CONSTRUCr
LIEN LAW INFOi2fv1ATI0N
DESIGNER/ENGINEER: —,Not Applicable
Name:
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address: a-o 30 3 7
Address:
City: v c t .a 13 e,.s2:�ff- State: G0
zip: 3a96d Phone:i;zL2
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 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
commencine woWor recdrdine vour Notice of Commencement.
STATE OF FLORID / STATE OF FLORIDA /
COUNTYOF1a COUNTYOF
The f ollflg-instrunt ent was acknowledged before me
this day of J 120f(o—by
(Na a of person acknowledging )
of Notary PubljeState of Florida )
Personally Known v OR Produced Identification
Type of Identification Produced
The forgoing instru ent was acknowledged before me
this S dayof 0i/-VS 20.j& by
(Name of person acknowledging )
(Mature of Notary P/ub ic- State of Florida )
Personally Knownf� OR Produced Identification -
Type of Identification Produced
MY �_5Commission No.Commission No. ;J LIEA #COMMISSION 132
Revised
JOANN FICO
Public • State of F
1171. Expires Jun 2.
Vional Notary
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