HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONR
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: & /%L- 0
SCANNED
BY RECEIVE®
St. Lucie County
Building Permit Application FEB 1 9 2016
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 _
• • • �yy�r�. L� is ,LWIM1\ 1IMMI �' 4
I PROPOSED IMPROVEMENT LOCATION: I
Legal Description:
PropertyTaxlD#: \
Site Plan Name:
Project Name:- \:_111112''A�.. 11
Setbacks Front Back: Right Side:
HVAC L_J Gas Tank
Electric 0 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ ��30
Left Side:
2
Lot No.
Block No.
is Lx�,
Piping LJ Shutters ❑ Windows/Doors
nklers 11 Generator Roof
S Ft. of First Floor: _
Utilities: Sewer 1-1 Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Na O lAl G
Address: v tJ2
Company:
l� do V
City:V V1QQcCJ State:
Zip Code: Q 51 Fax:
Phone No.
Address:k-,�^g`kSy1241P,C,1 lE
City: v NANC�_ State:��-
Zip Code: 52-90L'' Fax5Z1"12,Q gGU7
Phone No 92.\ `1 2.q 'L nS
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-MailUPn0,c>t ;P0-_ma,Iru" 4 cl m
State or County License:-,5cd i :7p� ISkok \
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name: -
_ Not Applicable
l
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:52D
�* asa
Address:
City:
Zip1\ Phone:
Stater
Z-5-bD
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
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
commencing work or recordin&vour Notice of Commencement. _
— ---N
STATE OF
COUNTY I
The forgoing in ent was acknowledge before me
this day o , 20)kby
person
Personally Knowny OR Produced Identification
Type of Identification Produced
Revised
MARLENE L. JONES
My Comm. Expires Jun 7, 2016
Commission # EE 205818
..n u,Gmal WM,,v Assn
COUNTY OF
The fo going instrument was acknowled ed before me
this day. 20I by
(Name of person acknowledging)
Notary Ppblic-,Atalk.of Florida )
Personally Known` OR Produced Identification
Type of Identification Produced
Commission N
C ?,ojglg (seal)
Notary Public - Stale of Florida
My Comm. Expires Jun 7, 2016
nnmmission # EE 205818
•
.°; ;
V Bonded Throug
a Ionallotary
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGET
A G 0 E
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
i
COMPLETE
11b
INITIALS