HomeMy WebLinkAboutBuilding Permit Application Apr 121611:24a p,2
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ALLAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -0'r% Permit Number.
• RECM,,:D APR 12 2016
Building Permit Application
Planning and DevelopmentServices
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: u ti`s C 1
Legal Description:_L..Gk,s, Lknoaj - �64 -1lm;A S-{3 9%K L4 Lo+ I
or 185 -�03►�
PropertyTaxlD#: Lot No.
Site Plan Name: Block No._
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
y}�` n't S��',�- i n5���ec.� �� n ���� i'"C�orr1 1 �c�'a�t✓ .
C;--?722 440-7
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CONSTRUCTION INFORMATION:
a workto a orme under s permit-Check a appy:
gHVAC Gas Tank ❑Gas Piping ❑OGenerator
Shutters Windows/Doors
1-1 Electric Q Plumbing F]Sprinklers 0 Roof
Total Sq.Ft of Construction: So. Ft.of First Floor.
Cost of Construction:$ Utilities: Sewer Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Ut�CMti Name: c,me5 i< bz. ,c-Ls
Address:Q 50k G4,c,- PL k B)VA- Company:3`1 m rn W'5 A/0 --f�rzl nt�.r� rsr�MnC_,
City:E-t. 17 i ti•C f State Ft-- Address: L4(a L-02 Y1 ° ,,_kf
Zip Code:3kCf-11 Fax: City: y 2252 State:__FL,
Phone No. -1 L q Zip Code: 3Z'9 to Fr Fax:77 Z-Zciq-31$�-�
E-Mail: Phone No. `2-i-L ?S 3S3
Fill in fee simple Title Holder on next page(if different E-Mail: r^f"%i (n5A rA �EQ;r.[.vrr,
from the Owner listed above) State or County License: 'r,-1wQ:-c
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Apr 121611:25a p.3
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 thepermit 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,l do hereby agree that I will,in all respects,perform the work
in accordance with the approved pians,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
commencine work or recording our Notice of Commencement. (�
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Si tore of Owner/Lessee/Aggrit Signa a of Contractor/License H der
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ncA tc, hi ems- COUNTY OF Z eyd l e-pn lb J e f-
Theforgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this '42 day of 4i rt �_ 20 Eby this 12 day of ft rY( .20 1a by
`7 Cl r&L _s E L i-Qu, .7
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary.Pub/lic-State of Florida)
Personally Known t/ OR Produced Identification Personally Known P_ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. rr f tf3 / (Seal) Commission No.FE 1 Y3gY& (Seal)
t:A•• ''v TERESA G.SUSEN
Revised 07/15/2014 Piotuy Public-Stafte�of Florida �'""h, TERESA 6DFlodda
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COUNTER REVIEW REVIEW REVIEW REVIE110--r
DATE
COMPLETE
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