HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE CCMPLET:`�� ��Ok APPLICATION TO BE ACCEPTED
Date: wo SCANNED Permit Number: l-&L-00sG
BY
St. Lucie County DOte 'Ap. F
RECEI V�-:D DEC 0 5 2016
it
Building Permit Application 0j;
Planning and Development Services
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:
Address: 'Pie-,rLc.�C- -54-fA Act
Legal Description:
Property-rax ID #: - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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AdditionalworKtObepertormed underthis permit- cneCK all that apply:
-Mechanical - GasTank Gas Piping - Shutters —Win�ows/Doors
- Electric - Plumbing Sprinklers - Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ '*%-S60.06 Utilities: -Sewer _Septic Building Height:
WWALSIER E-SSE N
Name:
Address'1'5'?2" Company: 10�� 12xil-e-Ily 6�ldrA/.�p
-cit)r State: IEL Address: 9��k? �*4yltvLci Rwl-&&
Zip Code: ?�,M,411 Fax: -Zi3&Q(7A City: 1,4ZE State;47-
Phone No.--73Z, .34� 61.5-t& — Zip Code: Y?Y--7 Fa x: nay/-
E-Mail: rg�yq- I" 0� Q fY\ Q-qAN0,A k i C-o r--\ Phone No S-7,1- �;/,J
Fill in fee simp e Title H�Ider on next page (if different E-Mail / 'Oef"-y 45��Iyv
4 6! �'Po�IA�
from the Owner listed above) State or County License e�rbl
1
if value of construction Is 2500 or more, a RECORDED Notice of Commencement is required.
NEER:
Name:
Address:
City:
Zip:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable MORTGAGE COMPANY: Not Applicable
Name:
Address:
State: City: State:
Zip: Phone:
Not Applicable BONDING COMPANY: —Not Applicable
Name:
Address:
City: city
Zip: Phone: zip:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permi� to Oo the work and installation is indicated.
I certify that no work or installation has commenced prior to the lssua6ce�6f i OermA:
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 io-anotherni:ib-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
commencinia work or recording vour Notice of Commencement.
I 4e
Signature of Owner/ Lessee/Contractor as A4ent for owner
S' n o ontrac Licens Holder
STATE OF FLORIDA
COUNTY OF
STA OF FLO, DA&
COUNTY OF
The forgoing instrurqent was acknowledged before me
this 90 day of KA UfAgLLv 201b by
Thefor inginstr t 3cknowledgeci before me
this AP of rV
3�� day 20a by
(Name of person acknow*dging
AL_�
r
(Name of p son ackno ledging)
I J LAJ�
(Signat6re of Notary Publi State of Florida
(Signature of Notaryfidblic- State of Florida
PersonalIV OR Produced Identification
Personally Known OR Produced Identification
Type of Identification AleNgid 14e Shawver
Produced " MISSIONW1492D9
iW11RE&ALIG07.2010
Commission No.
Type of Identification
Produced --*9LENE GRUNS
mycolls I #FFOIrA
Commission No.
&We
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW'f�
REVIEW'
7_'REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014 ; � ,