HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `
Date: I 1`7 Permit Number:
. AF�_ RECEIVED JAN 19 2017
Building Permit Application SCANNED
Planning and Development Services St. Lucie CountV
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: To Select from dropbox, click arrow at the end of line QC,, �U A � III
PROPOSED IMPROVEMENT LOCATION: III
"Ce
Legal Description:
Property Tax ID #: 13 12. S' o Leo $3 O o 0 S i �j12 QJ 0= �MLot No.
Site Plan Name: Block No.
Project Name:
Setbacks Fron Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
RAT d qIx 16 I
CONSTRUCTION INFORMATION:
Itiona wor to e e rme under t—checkispermit a apply:
11HVAC ElGasTank []Gas Piping _Shutters Windows/Doors
11 Electric 1:1 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: ScFt. of First Floor:
6 J Cost of Construction: $ 0 O Utilities: Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name O
Name:_!_HQ _C_�d
Company: r f T
Address: S% spoe I -st
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City: _ "f-+. , el-1 P tm�_ State. -EL
Zip Code::V1C?S I Fax:
Phone No.
Address: 122Sc:;' SQ I 4-. 5 O(D
City: i� om State:'(.,•
Zip Code: '�I A% Fax: OSL-IUQ 020I
Phone No. 3o:S �on o2o o
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: m %OUP I
^ Orr Q AQ!0
State or County License: C I S l 08177
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
;SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:'
DESIGNER ENGINEER• _ Not Applicable
Name: ioner orA775to I
MORTGAGE COMPANY: _ Not Applicable
Name:
Addre s: O
2
G r .
Address:
City:
Zip: Phone:
State:_
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 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
commencine work or recordine vour Notice of Commencement.
as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Si. Luc r2 COUNTY OF bacL
The ryunc�ning instrum nt was acknowledged before me
this z dayof� jrl uo I 20 jlby
person
The for oing instrument was acknowledged before me
this-Mdayof_ bnlJ0i •20 Lby
M a+W&L,)'Ec/el I
(Name of person acknowledging)
ft uI Ch�c1u� f dial C'h u� tl
(Signature of Notary P blic- State of Florida ) (Signature o Notary P blic- State of Florida )
Personally Known OR Produced
Type of Identification Produced aki
Commission No.
Revised 07/15/2014
Notary Pualk • auto
commission • 00
25,
Known
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REVIEW
REVIEW
DATE
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INITIALS