HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ( 0
iv
APR Z 5 2016
Building Permit Application PERr11TTING
Planning and Development Services St. Lucia 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:
PROENT LCAT ®N
Address: of l `
Legal Description:
Property Tax ID#: a�ag- 60— `ls acl —000 — 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILS® DE�S.CRI�PTI':ON 0' V1/ORK:
_._.150..iFmb1 I� r
C®NSTRtJCTI®N IN1=®RMATYON:
itiona. wor to a pe orme under this permit—checK.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: 60 Utilities:'=`-_-Sew,e''r _Septic Building Height:
OU1lNER%� ESS'EE� _ CONTR°AC�T®'R:
Name �.M '=Z Name: 6r•c- U n'e L,, si
Address: a I U a ��—�i;2U���'� Company:
City: State: r—L Address:
Zip Code: 3 Fax: City: State:_
Phone No. 11-a , 71- IMZip Code:3VV:I Fax: LN QS %o
E-Mail: Phone No. _aQ 0
Fill in fee simple Title Holder on next page (.if different E-Mail: (moo! Hyl ("A C��O .(fGS
from the Owner listed above) State or County License: LSC( (�C9M
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUP MI NI'ENTAL CO(VSTRCJCTION LIEN 1A/ y
a A INEOR�IVIATION ya
� '"iIPT-? .�`}�d � wa'4 -;F:.'Z:c1u.. ,'.,I
r
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 thepermit holder to build the subiect 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/Agent/L ssee Signature of Contractor/Licens older
STATE OF FLORIDA STATE OF FLORIDA >' CO
COUNTY OF COUNTY OF
E;
The forgoing instrument was acknowledged before ed o N The forgoing instrument was acknowledged before me p,z M cu
this S�day of Pt Pr:l 20 1& by O � � . this J day of fapr; � 20jby
0 Z ? J cn 2 z
}( o
in � Z l��I� N 0 W
J cn o J��t'iV f� O CC LL
(Name of person acknowledging) M o a: o (Name of person acknowledging) V w
gv aL) X LL
esell,
(Signature of Notar Public-State of Florida ) t (Signature of NoVrry Public-State of Florida ) .h,;s`.•
7 MY
Personally Known OR Produced Identificati n •.'. _ Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. 0 j (Seal) Commission No. 1r-Fac/&Lio'5 (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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