HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: � 'ZC. � �n Permit Number: n
RECEIVED
d JAN 2 0 2016
__.. .._ .F ,. Building Permit Application
PERPJIIITING
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial _X_ Residential
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PERMIT APPLICATION FOR:f-y�.C-A A n I cN) UA C__PROxPOSaED'INPROVEMENT LOCATION MK
60&
Legal Description: _ Ub
rapent"�y �a" I'.D , Jr O " d 2 =2 — DUb % Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF 111/ORK
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CONSTRUCTION INFORMATION . .
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Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank -Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: DMZ . D D Utilities: —Sewer —Septic Building Height:
.OWNER/LESSEE ., °CONTRACTOR
am e: 'o ,a �L
Address: 5 � �/�- ompany7.�. AGE b' N
City: S�i,1�1/'/i State.F Address: L 'e c', �r
Zip Code: 3 Z/7 Z e Fax: City: �S State:Ez—
Phone No. ��- BOJ D %ti Zip Code: 3 %� Fax:
E-Mail: Phone No 7 70 - ,P,9Y-
Fill in fee simple Title Holder on next page (if different E-Mail G
fro the Owner listed above) I State or County License 4 C >' 17 a3.�"L'
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION"LIEN LA' INFaRl111ATION:
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 contiict 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 our Notice of Commencement.
Signature of Own r/Lessee/Agent Signature o Contractor/Lice a Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF - COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of Pt lg. 20-LU by this Z day of figt4— _,20_]_bby
( ame of person ackn wledging (Name of person ackn wledging)
(Signature of Notary Public-State of Florida} (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Ident'
ation Bmf Identi tion
Produced °",,:, KAREN S. NIEL"Ptbdu d-- '— -- ''�'' "�'•,a,,, KAREN S. N1EL. F. !
Commissio:,# FF 1 '5637 _ Commis o:,# FF 115 7
'"� Commission Ex Edi s
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Commission No. { �� Sal}My Commission E pm i sion No. s4 ay
` June 72, 2Qi8 ea June 12, 2Q1 .
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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