HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i
Date: Permit Number: I 01'
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Building Permit Applicati®n
Planning and Development Services PERMIT IW-::
Building and Code Regulation Division gt.Lucie County:
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: SAI SA?C-115
PROPOSED INPROVEMENT LOCATION:
Address: ` %o? 9 SSAd2 f C rll-r ele
Legal Description: foe
Property Tax ID#: 33 Z/ ,S/-Q/" G Z l% ' O d 0 ! Lot No..
Site Plan Name: e4 of'" c� Block No.
Project Name: ,lam.+C
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: :
C o /G �, iiyre
CONSTRUCTION INFORMATION:
Additional wor to be pertormed under this permit-check all that app
_Mechanical _Gas Tank Gas Piping X Shutters Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
d �
Cost of Construction: $ d ay Utilities: _Sewer _Septic Building Height:
OWNER_ /LESSEE: _. CONTRACTOR:
Name r✓6 w l Name: 5p-,V Lv G L
Address:_ 2 f4a,/ 04 2 12/4 . Company: - C- �-A: SCJ �-�e ,� L`�• I L✓C .
City: 12L State:FZ Address: (:3(/l
Zip C(Ie: 3 91 Fax: City: 42? Stater
Phone No. Zip Code: 3 3 Fax:
E-Mail: Phone No. 92
Fill in fee simple Title Holder on next page ( if different E-Mail: �1 cs S-) ,S� V4-Grt L 1 @ G n-cgJ..
from the Owner listed above) State or County License: g
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW.INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: INot Applicable
Name: Name: 7��
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 recording our Notice of Commencement.
J --?, J —-- J
Sign ure of Owner/ gent/Le a ;TATE
gnat a ontractor License Hol er
STATE OF FLORID OF FLORI A�
COUNTY OF COUNTY OF�)\ o lvAJ--,
The afoing instr( men was acknowledged before me The fo oing instr ent as acknowledged before me
thisday of a ( 20by th is-i0dayof 20by
(Name of person acknowledging) Name of person acknowledgingLj��L
)
_ i"
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nature of Notary7ORkPraducedIdL-n
ate of Florida ) (Signature of Notary Public- ate o Florida )
Personally Known. 'fi tina Personally KnowO Produced Isleritifiiat�n. .,
Type of Identification ro rice oAwn ONE Type of Identific ioR,.?p.duced DAWN mit nNF
v ,o<r
Notary Public-State of Fle ida ;r* .+� Notary Public-State of Florida
Commission No. '„ My Co*S&Oires Mar 22,2017 Commission No. • •?My Comm.Exp(i5eJ0 a)r 22,2017
Commission#EE 877571EOFcIOp`� Commission#EE 877571
''"OF F '� Bonded Through h National Notary Assn. Bonded Through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER . REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014