HomeMy WebLinkAboutBuilding Permit Application ALL APPLIC BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED //'��
Date: Permit Number:�{)�� ' V
RECEIVED
Building Permit Application JAN 2 5 2016
Planning and Development Services
TI NG
Building and Code Regulation Division Lucie aunty,
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie County, FL
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line S\_By2s
PROPOSED IMPRO.VEM.ENT"LOCATION
Address: �Q�2S LJVt'i rJ�r�i L�
Legal Description: (2:Ak Lo+ � cble/\ e-
Property Tax ID#: a I / I 001c), oco( Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION'OF-WORK
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.,CONSTRUCTION INFORMATION.
Additional work to be performed under tis permit—check a app y:
HVAC Gas Tank ❑Gas Piping _Shutters a Windows/Doors
11 Electric Plumbing Sprinklers E Generator El Roof
Total Sq. Ft of Construction: *coy, qzo t Sq. Ft.of First Floor:
Cost of Construction:$ 67ZO,OD Utilities:0Sewer E]Septic Building Height:
OWNER/LESSEE .CONTRACTOR
Name k�or-ma n Gula o`)G17 Name: dS 'X,
Address: (,( LAI Company:
i
City:�- , cQi^ce. Stater(, Address.--,;Q
Zip Code:3Ltl' 40 Fax: City: Ie(`ze.) State: �L
Phone No. _1_7 Z S (q (e&'9S Zip Code:N2 �44�2 Fax-
E-Mail: A101YO.N90Ildjl)Qo..CDri—, Phone No. -�7?hD to
Fill in fee simple Title Holder on next page(if different E-Mail: 0 (0
from the Owner listed above) State or County License: C P(2� 14519 0
IL=nstruction 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: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: 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 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 inspec 'on. If you intend to obtain financing, consult with lender or an attorney before
commencing work o r cordin our Notice of Commencement.
Lessee/Agent e • "UntmrnmidLicense Holder
STATE OF FLORIDATATE OF FLORIDA
COUNTY OF Sl . Lim�t' COUNTY OF --4. kAC,ei
The forgoing instruent was acknowledged before me The forgoing instrument was acknowledged before me
thiscS day of 20 [by this day of Jg4, ,20/ P by
LL e)r ryly"A �-C� mimes A . (.oa- Ipe--
(Name of person acknowledging) (Name of person acknowledging)
(Signa t a of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known J' OR Produced Identification Personally Known �OR Produced Identification
Type of Identification Produced Type of Identification Produced
'0 SUSAbbt WALKER (Seal)
Commission No. ••°o�:�•••�••-B�•=, Commission No. FF o��/0'1 -� Seal
MY COMMISSION#FF184063
EXPIRES DeGGFRb0F '2018
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Revised 07/15/20 07)398-0153 FloridallotaryService.com ?r: .;i Notary Public-State of Florida
' Commission#fF 231072
do
:'F �.o? M Comm.Expires Jul 28,2019
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