HomeMy WebLinkAboutBuilding Permit Application R-
,PkICABL15INFO MUST BE COMPLETED FOR APPLICATION''TO BE ACCEPTED
Date: 1-011-16 Permit Number:
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Building Permit Application
PERMITTING
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1555 Fax:(772)462-1578 Commercial _ Residential
PERMIT APPLICATION FOR: tq\eG ici1
Address: ���� t2h�m70f+ oGQil2ll�
Legal Description:
Property Tax ID#: L I25-- "elli,9�� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
AoultionalworKtoneperformecl undertnis permitcheck 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:$ /���-'' _ Utilities: _Sewer _Septic Building Height:
Name e6r A. Czoo _ Name: L'u��is S .mmon_5
Address: /'I Cl_,e r- e of Company. Air 5 e n
City:,rO& Z'f V Pr State.LF Address: l( 15 S �1+1 a�� .fir
Zip Code: _ �'/,5.� Fax: City: POL7 Sr Lite►f. Stater
Phone No. Zip Code: 34 5;2; Fax: `17 33s- o4.
E-Mail: Phone No. 17�2
Fill In fee simple Title Holder on next page (if different E-mail: c7u stqr 01
from the Owner listed above) State or County License:
if Value of construction is2WTor more,a RECORDED Notice of Commencement is required.
DESIGNS ENGINEER: Not Applicable
Name: MOaTGAGE COMPANY: Not Applicable
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:
Zip City:
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 Count, makes no represent tion that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any appiicab�e 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 recordhpg Yourrecord' Notice of Commencement.
Signature of Owner/Agent/ essee Signature of Contractor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF t
The forgoing Instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day ofQ4-;,LJ 20by this_.eZ/day of zpZ:�,by
--._---. t�U�•Ti�" �/yI�ID - _ .. /��f.,�T/�sn J�f/yJ�G�/� C•
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Zbblic Se of Florida) (Signature of Notary Publi 4' to Florida)
Personally Known OR Produced Identification Personally KnownY_,�/OR Produced Identification
Type of Identification Produced Type of identification Produced
� � � y per% limNe 8.E 4 G �,. •. CHRISTINE 8.FNGLl9r
Commission No. �,?•••. (S pN645StQN E�868 Commission No.�E��Y�� (COMMISSION#EEd5s2ati
SXPtRES:APrll4,2017 EXPIRES:april4,2017
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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