HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: • I l� Permit Number: 0 o n
9 JE
APR 0 6 2016
Building Permit Application PERMITTING
Planning and Development Services Si. Lucie County, FL
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:
P aP�SED lR•4�(EMENT
Address: bar-bo-na k)-e- P'e rcPa
Legal Description:
Property Tax ID#: �F �-- (L�[�, — ill o nLot No.�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
® ETA119 E;I I DI D:E�S'CRIPTION OF WORK:
s
e C iCk S PFJ -
WL
eoNS�TRucTION INFORMATION:
Additional work- med Under this permit-check all that appy:
_Mechanical _Gas Tank —Gas Piping _Shutters- _Windows/Doors
Electric Plumbing _pSprinklers _Generator _Roof
Total Sq. Ft of',Construction:. ���. . T• .. Sq. Ft.of First Floor:
Cost of Construction:$ �.�� Utilities: —Sewer _Septic Building Height:
®WAN ER/LESSEE: CQNTRIC*tl-®'R:
Name. , 2 , ame:/41164mff;COun 1S0i1Ue(5 (2eNlo e er_5
Address: . 3C�`-I' T'_b0.i-C,0. �P • ny. �a`✓(i.e.(. :=ZG is w5�cn� _r
City: e f C42 Stater Address: �bO
Zip Code: Fax: City: PorNSr IL�c`� State: FL
Phone No. ?��- �((Q ( - l � 8 Zip Code: 7 S Z Fax:
E-Mail: Phone No ?7 a 75
Fill in fee simple Title Holder on next page(if different E-Mail CjG.✓I t o_( corp
from the Owner listed above) State or County License CPLCoA-G a��
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTR 'CTIQN L��N LAW ! 'F�RMATlON:
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 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 recording our Notice of Commencement.
Signature of Owner/L ss _e/Agent Signature of Contract icense Holder
STATE OF FLORIDA STATE OF FLORIDA 5
COUNTY OF � i�� ,( COUNTY OF
The fpzgoing instru nt knowledg�ore me The fo nstru ent a cknowledggd efore me
day of 20 this I)�d"ay of 20ff(�',by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of ry Public-State of Florida) (Signature of Notary Pub l' -State of Florida)
=Personallyown OR Produced Identificationrsonally Knows OR Produced Identification
ificat' Type tifica
Produced
ANGELA FF
• _ Notary Public( �
Commis iQs$���"p�''•, "VUtLg ea Commission No. :•= 1Florlda
;�c Notary Public_ M_HUFF i y°'a P`o`,�My Commission#FF234730
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REVIEWS F Through a �2019 SUPERVISOR PLANS VEGETATION SEATUR L OVE
COIrNl'ER� REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. /2014