HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: IS 1p Permit Number: y
r 9-
,� JAN 15 2016
Building Permit AppPERMITTING
lication St. Lucie County, FL
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
PERMIT APPLICATION FOR'
PROP®SED 1N.PROUEMEN``f rLOC`A/TIt71U:
Address: �� �..f� yUly V — b�� _?� VG( � 3M,
Legal Description:
"Prope"r t Tax�l19 �� Q2 �,� ��� 07 Lot No. I K Co
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED D:ESCRIPTION OF WORI
}
r
C®NSTR�UCTION hNfOR11�ATI0N: _
..
Additional work to be peFFo-rmed under tis permit–c ec all that apply:
_Mechanical _Gas Tank _Gas Piping =Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Constructi(oa� Sq. Ft.of First Floor:
Cost of Construction:$ �' 2 60. Utilities: —Sewer —Septic Building Height:
ODU N'ER/LE�S' EE: CONTRACT®R:
armee Name:
Address: Company:
City: Stater Address:
Zip Code:, Fax: City: State:
Phone No. &C91 5c)(P A8.�A ,,L .1. Zip Code: Fax:
�
E-Mail: O Y& a_1 Cb i kcA�l ry.;' Phone No
a
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
IJPPREMENA SAL MR] 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: Not Applicable
Name: Name:
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 applicablelHome 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.
1
igrsat - 'f,0u�n`/-ILesse ontractor as Agent for Owner Signature of Contractor/License Holder
iI . ... _ _
STATE OF FLORIDAJ ,
STATE OF FLORIDA
COUNTY OF UC Ik. COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_Lt_day of 20 I_&by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
r,
(Signature of Notary Public-State of Florida ) (Signature of Notary.Pu.blic-State of Florida)
Personally Known OR Produced Identification v/ Personally Known OR Produced Identification
Type of Identifi ation tification
Produced KAREN S. :FF1
DN8d
```o4'pY Pyel n�i� ..
Commission# 637Commission No. , My Commissig�sio No. (Seal)
June 12
gn,na
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014