HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONN
ALL APPLICABLE INFO'MLIST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `\ ��'�` �� Permit'Number: 1 09 - 131A01 i
RECEI" .D SEP 23 2016
Building -Permit Application SC BY
EU
.Planning and Development Services t
Building and Code Regulation • Division St. Luole cotln ,
2300.Virginia Avenue, Fort Pierce FL 34982
'Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial. Residential,. -
I. PERMIT APPLICATION FOR: To Selectfrom dropbox, click arrow at the end of line \oAk\ S,q t1 III
Address:
-Legal Description:
Property Tax ID #: _ 3411 Li ` So i 1 ? d l —000r / Lot No.
Site Plan Name:
�u Block No.
Project Name: h 7g ez &#S zoo/
Setbacks .Front Back: Right Side:. Left Side:
DETAILED DESCRIPTION OF WORK: III
i4CL Gl1'1 P
CONSTRUCTION INFORMATION:
HVAC Lj-Gas Tank
Electric D Plumbing
t�o1P _i1g.,�
el e cA-e
Piping U Shutters U Windows/Doors
nklers O.Generator .'Roof = Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of•Construction: $ �, n 106 Utilities,Sewer 0Septic Building:Height:
OWNER/LESSEE:
CONTRACTOR:
Name 60YA&±±1 SyllOwt Lor/0
'Name:' FereQ1J J'?4�✓S
Address: g1n0 S eu c
Company:
.City:- PSL Stater
Zip Code: Fax:
Phone No.
Address: 2-y 2do71l S-r
City: B State:��'
Zip Code: s?-Z V O 7 Fax:
'.Phone No.
E-Mail:
Fill in fee simple Title Holder on.next page.(if different
from the Owner listed above)
E-Mail: a rn A t' fe�PR. ✓S>c�t. �o
State or County License:
(I If value of construction is $2500 or more, a RECORDED. Notice of Commencement is required. II
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City:
Zip: Phone:
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
.Zip: Phone:
Zip: Phone:
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 ano 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 1 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
P�
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF pc,, .eZ«- COUNTY OF . mac/
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this Z1 day of 20 Eby this Z-F day of Si w Buz 20 (.6, by
2Cu1./J� L./ t�lr7elG �llti. L.I CL✓✓kl�c
(Name of person acknowledging) (Name of person acknowledging )
(Signature of Notary Public- State of Florida) (Signature of N tary Public- State of Florida )
Personally Known
Type of Identificati Pr(
Commission No. J
4
Revised 07/15/2014
Personally
Type oflde
Notary Public - State of Florida
Comn(Beiol� r FF 995383 Commission No.
Ay Comm. Expires May 23. 2020
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REVIEWS
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PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
16
INITIALS