HomeMy WebLinkAboutBUILDING PERMIT APPLICATION_'T
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
BY
St. Lucie COunty
Building Permit Application
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
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �Jhii�i OW-J-� 1z I
PROPOSED IMPROVEMENT LOCATION:
1% Wv0m,&j9 Ave , j�;rk �Ier-u rL, -
Address:
Legal Description: O(ZL% 965.,,1 A,-D� gik C,.�IA(,Ygr 3W-,
PropertyTaxlD#: 07%*60�-000g-000-3 Lot No. E,
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side
Left Side:
DETAILED DESCRIPTION OF WORK:
So /[brJ loAol
WATt-1Z
CONSTRUCTION INFORMATION:
Additional work
11HVAC
to b ertormed under
M Gas Tank
this permit -check
E]Gas Piping
all
apply:
Shutters Windows/Doors
E
11
D�rplumbing
OSprinklers
11
E]Roof
Electric
Generator
Total Sq. Ft of Construction:
Cost of Construction:!� 22.-�:
S Ft of First Floor:
Utilities"n Sewer E]Septic Building Height:
OWNERAESSEE:
_qQNTRACTOR:
Name Altxhe5h e Fil k A 46h4mlia"me:
Address: 1/,�11 AJALZO�AO,9_7FF gfk� 1--k
WdMjlu,4,9� Xid
Uqid &_roce5
Company: 4�Afttg,) 'P. M
A (ESALA
City: V State:
Addre s:. W91 SuJ Aq� MlAbc),]
Pue.
Zip Code: Fax:
City: Pm� r,,k J
State:
Phone No.
Zip Code: 3J990 / Fax-77)
E-Mail:
_
Phone No. '-77,)- ?P3-1S5(o
E-Mail: eae 6-5& M
Fill in fee simple Title Holder on next page (if different
State or County Li�ense:
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN ER/ENGIN EER: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
Zip: Phone:
City;
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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an9covenants 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
commencina work or recordine vour Notice of Commencement.
Signature of O�,I�rl Agent/ Lessee Sig��f Contra cto r/License Holder
STATEOFFLOR'D� Lx)6-4,
COUNTY OF 4-
The f going instrument was acknowledged before me
this 1K day of Z 0, Y\ 1 20 16 by
-'s <� 'f"rt- S V%A f '4 O"N!k
(Name of person acknowledging)
(Signature of Notary PubliatState of Florida)
STATE OF FLORIDA I
COUNTY OF- H C'
The forgqing instr
.�!Went was acknowledged before me
tlhisZt�tclayof 20_j.6 by
7Tr,-Vy\.e 3 H CL*S ai C'�_
(Name of person acknowledging)
.J
IS-ig-nature of Notary Public- State of Florida
Personally Known OR Produced Identifica i� Personal t1lKinown C-14WICrAHIfthntif ication
P I
Type of Identification Produced Ty I , tification ProCN0tdn;i:.&. L " Z' 4 r-
c
11 . �
is
Commission No. sl State of A rida (Seal)
Cokpissil _ Mo. 0
�e' OF rlsft� MY COmmission Expires 10/27/2015
ro
Revised 07/15/�Q�4,.
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