HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE I FO 7/ 6
ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L Permit Number: lS!v ^ Q
R 1E 1 i
MM
APR 2 7 2016
_ Building Permit Application p P AITTING
Planning and Development Services St. 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:'-v>`vWi
PROP.®SED lN'PRO�IEMzENT LQCATIQ:N: a
Address:
Legal Description: I/1J D/AnJ t �S l�l tJN l gt 1C �o%S fI Nl�
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Property Tax I D#: - -9'-]6.2- on 1 00 1 " 000 `2— Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
�IDBSI;! PTI®N OF 111108=K: z: _
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CQ'NSTRal1CTIO LNF®RNI TIO'N::
Additional work to be pe orme un er 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:$ C� � •�� Utilities: —Sewer —Septic Building Height: .
ern nom,
�LE�S EE: C®NIRA TON.
O1J(�ER/ A P
Name GC_72 A VCY Name:
Address: y0-y1z/gDLC-y S Company:
City: 1 tolacc State:_& Address:
Zip Code: '?Y5 lea Fax: City: State:
Phone No. _7D 9 _?Sl 57T f e Zip Code: Fax:
E-Mail: %y Y'1A'1 'X 66 9"/& Y4q00'C6y-) Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S'U�PLEMENl'AL C�NS�l"RU =@N iENI LAUUA I'N!F®RMATION:
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 inspeAtion. If you intend to obtain financing, consult with lender or an attorney before
commencing wor rding your Notice of Commencement.
Signature of Owner/L ssee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF . COUNTY OF
The forgoing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
thisc�day of 20_�A by this day of 20_ by
(Name of person acknowledgin ) (Name of person acknowledging)
lrlA 0
CE
(Sign ture of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification .1/ Personally Known OR Produced Identification
Type of Identif"catio Type of Identification
Produced ed
KAREN S. NIEL EN
�`O FpY OBOrli
ommission # FF 115 37
Commission No. _, eaI �o�n ssion No. (Seal)
o.
y Commission E e
i�„f OF f�O�\\� June 12, 201
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014