HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �dl ay 1 yo- Permit Number.
RECEI'.'-:D OCT 24
2016
Building Permit Application SC N ED
Planning and Development Services BY
Building and Code Regulation Division St. Lucie County
2300Virginia Avenue, Fort Peru 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
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`PROPOSED IMPROVEMENT LOCATION-
Address:
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Legal Description:
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Property Tax lD #: I I N 10— Z J� t 112 '�� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAIL! D DESCRIPTION OF WORK*:
VbI I Y2�1f' ( (Nr ) 401cce Gloss
CONSTRUCi'ION INFORMATION:
Additional worK to be e orme un ert isper mit-c ec a appy:
1JHVAC ❑Gas
Gas Tank Piping Q Windows/Doors
_Shutters
Electric 0 Plumbing []Sprinklers Generator ❑_ Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ A Jw • Utilities :Sewer Septic Building Height:
OWNER/LESSEE:;
CrOR: -
GONTR,4CLOR:
Name ti VXt'A
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Name: l
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Address: bNo rJ
Company-,mnCNpli fl
City: 'IY1mPpf State: w
Address:�i) .gbX la�l�-i
Zip Code,.Fax:
CGty:. IP.(CD State:
Phone No._ IN2j
Zip Code: -RLWI Fax: �IA
E-Mail: P,V P-
Phone No. '7 — 1
Fill in fee simple Title Holder on next page (if different
E-Mail: M WQ I ink},, Can
from the Owner listed above)
11
State or County License: rr q�
of rnnstruction is $2500 ar more, a RECORDED Notice of Commencement Is required.
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RECEII'ED OCT 24
SUPPLEMENTAL CONSTRUCTION LIEN'LAW INFORMATION:. III
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
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 Commenceme t may result in your paying twice for
improvement o your property. A Notice of Commencement must recorded and posted on the jobsite
before the f At inspection. If you intend to obtain financing, consult ith lender or an attorney before
Signature cf nef'/ Lessee/Aggnt - b nature or u
S Signature
1 ��u COUNTY Of
COUNTY OF L -t
The for oing instrume t was acknowled a before me The for oing instrxme t was acknowledg�jd before me
this day of 10�✓ 20 Uby this day of tlJ b PrJ_ 20 1 �9 by
rn) -Aad, LdAAvaQ . ►� c hoe f 1 N o� oy� .
(Name oaf\person acknowledging) (Name of \person acknowledging)
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(Si�n�ntu l f Xt�rydeXi��tate of Flori¢g Q,,.•••••., �i� (Sign �Y $ t�nLPt� c t e of Flori�da�.�` `�,.• '�\SSION :Y
�ittSS �N cd \sS10N��,• 'vO��gryp,?o�°q
Personally Known OR Produced�deei ona011a p*s * Personally.Khown OR Produced ld3*fks�isn�•� O
Type of Identification Produced s—i��-.� ? ype of Identification Produced
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Commission fSo. FPlg5337 Vol �gF� � 10 Commission N
Revised 07/15/2014
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