HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED —
Date: IQ. cm SCANNED Permit Number: &
St. Lucie COlInt" RECEIVED
Planning and Development Services Building Permit Application DEC,2 0 2016
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
,PROPOSED IMPROVEMENT LOCATION:
Address: 3 i 06 Al. /� / & 3WIT
Legal Description: 514,V_9�' h 7%, L1. w� P�tZ�Q,� Z-T 3zlb-a
PropertyTax[D#:
Site Plan Name: _r)(e _!�4_woz 9,v 71L Oe4rn,
Project Name: _-S7,4A4Z_-
Setbacks Front Back: _ Right Side: Left Side:
Lot No.
Block No.
I DETAILED DESCRIPTION OF WORK: i III
e
I CONSTRUCTION INFORMATION: III
AcianionaiworKICIDEPerrormea unaerinis permit— cneCK aii appiy:
1]HVAC L1 Gas Tank OGas Piping M Shutters D Window<� �Ors
UElectric 0 Plumbing []Sprinklers liGenerator Roof
Total Sq. Ft of Construction: le S Ft of First Floor:
— 'c[2 Sewer Septic Building Height:
Cost of Construction: $ 7 It -7 oe? Utilities.
OWNER/LESSEE:
CONTRACTOR:
-1�.e_ _S, . -
Name— Or� e,&�,
Address: 31011) ,4 /A
Name: z
Company:
City: —e A-e- State:
Zip Code: Fax:
Phone No._2 -7 2- - -3,32- -z�3
Address: 443a-5-
City: ege_ �e_ State:
Zip Code: Fax:
PhoneNo.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: A in, We— &' Aa6,11A'Ale-f
State or County License: CGC-0_3r�d*
If value of construction is$2500 or more, a RECORDED Notice of ornmencementis required.
SUPPLEMENTAL CO
ON LIEN LAW INFORMATION:
Name:
Address:.
City:
Zip: —
FEE SIMPLE TITLE HOLDER -
Name: 7rx-.-- _5"+,/y/
Address: 3
city: F -�-"
Zip: f�/ Ph96e:
Not
State:
Not Applicable
MORTGAGE COMP�X.
Name:
Not Applicable
Address:
City:
Zip: Phone:
State:
BONDING COMPANY:
Nam
—Not Applicable
Add
City.
Zip.
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 ma estrict or prohibit such
ic
structure. Please consult with your Home Owners Association and review your deed for any restrictions y4i h may apply.
w
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
commencing work or recording your Notice of Commencement.
0, g- �< I (�L7�& -S
Signature of Owner/ Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF
COUNTY OF
c�
The f ing instru acknowledged beforE 12
The forgoing in umen was acknowlecig d bef
S UME t 0
=t
this 7clay of 20 L(9 by
this dayoFl= 20 i(o b
T'-.
__
SiM g
E E
��2b
13
(Name of person acknowledging)
(Name of person acknowledging)
Z
E
=5
Mm
(Signature of Notary Public- S&te of Florida ) I (Sigri-a-turb of Notary Public- Sta�6 of Floi
ion Personally Known OR Produced
Type of Identification Produced '7Type of Identification Produced
Personally Known OR Produced Identificat 7�7
Commission No.
Revised 07/15/2014
(Seal)
Commission No.
(Seal)
REVI EWS
FRONT
ZONING
SUPERVISOR
P N
X
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
RELVIE 1.
REVIEW
REVIEW
REVIEW
DATE
I
COMPLETE
INITIALS