HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLET4. ",OR APPLICATION TO BE ACCEPTED
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Permit Number: (� /
Date: SCANNED
BY
St. Lucie County
dt _,v._ _ Building Permit Application SEPP -6 2016
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- Planning and Development services Ave- r/ 1 " W
Building Code Regulation Division d,c) 6 — 6�/jo
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2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITAPPLICATION FOR:
MUMA;®SED INPRQVEMENT LOCA�T ONe
Address: 15 2�! 6us�n�ss Par Q� �4 F'LL�3L/�SZ
Legal Description:ST-LZUelr AC,�pAeSS P�� G.d �5 Sy4
Property Tax ID #: #R6b[< 0 -`702 000(,, —i9 0— H Lot No.454 6
Site Plan Name: ' Block No.
Project Name: w - Laere nl aatAe5s, 1 r
Setbacks Front Back: Right Side: Left Side:
DETAIL D DESCRIPTION OF UUOR'
-
GON �TR:LICTI®N tNFQRMATIO, N'
itiona w rK to De perlormea uncler this permit = c ec all that ap.p y:
i
_Mechanical _ Gas Tank _ Gas Piping, Shutters Windows/Doors
_ Electric .—Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of'First Floor:
Cost of Construction: ${ 375 Utilities: _Sewer _Septic Building Height:
WNERESSE
CONTRACTOR:
Name: ei\ tC efn'
Name OA e Yr eS LC
Address: W'zS,3
Company: /VetJ CU/I o
City: z2 State
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Address: I/9 sw C'S�I
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City: � m / State: v—L
Zip Code: A [ 9 5'1 Fax:
Phone No.� �0 %^�o�`j
Zip Code: �96�v Flax:
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E-Mail:�v 4 M <uh /Lo�1 F21 r.a oe a aov�
Phone No Ul n �1y�7
Fill in fee simple Title Holder on next page (if different
E-Mail
State or County License \ 011
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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:
SUPPLEMENTAL GONST � I®N LIE LAVI/ INFORMAjTfON;
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 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
commencingwork or recordin our Notice of Commencement.
Rev. Signa ure of Owner/ Lessee/Contraqof
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as Agent for
wit'ei•`
Sign ture of Contractor/License Hol
STATE OF FLORID
STATE OF FLORID
COUNTY OF
COUNTY OF
The forgoing instru nt wa acknowledged before
this � da 20� by
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The fgrgoing instrume wa acknowledged befor
this CrJ day of 20Li by
Wy
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2 � $ �
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y of
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ame of person acknowledging)
(Name of person acknowledging )
(Signature of tary Public -State of Florida)
(Signature of NotOy Public- State of Florida )
Personally Known / OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEPV
REVIEW
REVIEW
REVIEW
«REVIEW
DATE
RECEIVED
1
DATE
COMPLETED