HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: O�
RECEIVE
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uilding Permit Application FEBF01 2016
Planning and Development Services PERtd11TTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: 13-3Oq M W d11LAn149 ct00 CfZ� '/
Legal Description: I'T/acbou.✓ 12.o c£ �1e.r 13 1?>,4 -46,.,s Y i t�, lJ�••; a 2-9
PropertyTax ID#: 441MAo- py3Lel- O��•�J Lot No.
Site Plan Name: Block No.
Project Name: (-on:j S_-_**V i am-o
Setbacks Front Back: Right Side: Left Side:
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Additional work toe e orme under t -checkispermit a appy:
HVAC E]Gas Tank 0Gas Piping _Shutters Windows/Doors
❑Electric ❑Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ Z4 1� Utilities:Sewer 0 Septic Building Height:
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Name W1. 'oDo✓ie-w140 Name: Peter A Cafaro I I I
Address: 1-3165 NW MAQ*uicoc-1 4-0 Company: Lowe's Home Centers, LLC
City: ]�At__ U 4-lf State: FL Address: P.O. Box 781993
Zip Code: SLICK Fax: City: Odadno State:FL
Phone No. '1'17-- 'ay�1 -`i 3'z-� Zip Code: 32878-1993 Fax:
E-Mail: Phone No. 516 I - 741 - 66 I(
Fill in fee simple Title Holder on next page(if different E-Mail: rD ;�•y-: � h®-lw.,.;l . ��^^
from the Owner listed above) State or County License: CGC1508417
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: I I Name:
Address: Address:
City: State: ( City. State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: of Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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 iB,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 propert . A Notice of Commencement must be recorded and posted on the jobsite
before the first inspec yo intend to obtain financing, consult with lender or orney before
commencingwor recordi Notice of Commencement.
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Signature of / ent/Les e Signature otFLORI
ntra r/ ' nse Hol
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STATE OF FLORI STATE OF A
COUNTY OF-SLC ` COUNTY OF SLC
i The orgoing instrume t was gcknowlecled befor me The fnrsoing instrurrgnt wqs acknowledge. ore me j
th ay of 20y thisZ%F-day of20LMby
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Peter Cafaro III �'" ! Peter Ca`aro 111 I
(Name o fp o ackno ging} II (Name of person ac• to
(Signature of Notary Public-State of Florida) i (Signature of otary Public-State of Florida)
Personally Known X OR Produced Identification i Personally Known x OR Produced Identification
I Type of Identification Produced Type of Identification Produced
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,,,, (Se&IhCH BOCOOK Commission No. E# EF
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Commission No. ,._:,.,'., _
. ,.` Notary Public-State of Florida 1 = Notary PuFlorida
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Commission#EE 176869 �,;rF tea,. Commts6869
o,`Revise 0%/1S/20 Banded Thrcuoh National Notary Assn. Bonded Throury Assn.
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