HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED T�
Date: Permit Number:
,. : MAY m 4 2016
_ Building Permit Application Public Works
St. Lucie county, FL
Planning and Development Services
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:
PROPOSED INPRO�/'EMENT LDCA H(
-N.Mom
: ,
Address: � 23 G.rhkj wlcy1�iw1y,ll4�c.
Legal Description: 260 26 AT ,e. C��" �(��Str ( �•/pw�S t'a��} L,� 53 04 -LN L Z 2 57
Property Tax I D#: )3�L7 -70-7 leo 5��� oy(3 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DE�SCRd�PTIQN OF U1fOR�K: x
Ar4Jo5nc Gas Peylfif
lig! I
C®`NSIJCliON I'N`F®R91�lI4TION:
Additional work to be performed 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:$ ���Uy Utilities: -Sewer _Septic Building Height:
®WNER�LESSLE• C®NTRA AOR:
Name c war G����I� eG` am ►-� �JV-,e-1'
Address: g1231-iv+lcl%1<L%4Company:#11 /116'k 6W 44-t"IMCh"//'11l+r
City: v�� 551 (.uc�e State: Address: 105-19 5L,/ YTS
IZ
Zip Code: 3Y`��� Fax: City: ?b/, State
� 5���� `�ccE :
Phone No. 7 (o Zip Code: Fax:
E-Mail: Phone No ya.7 76� 237 3
Fill in fee simple Title Holder on next page(if different E-Mail jCrl'[C/File., 211 @�•�Qi. •may'"
from the Owner listed above) State or County License
01 X31
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S�IJPPLENIE'Nl"AL.CUNSTR�IJOffif N LIEN LAW IN'FO'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 p perty. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspect�ordiyoyour
u intend to obtain financing, consult with nder or an attorney before
commencingwork o Notice of Commencement.
Signature of o/w er/ see/Con actor as Agent for Owner Signature o Contr torp/cense Holder
,
STATE FLORIDA ! _ - STATE OF FLORIDA
COUNTY OF LCJ\ COUNTY OF
The going instru t was acknowledg d efore me The flgoing instrum t was acknowledgre me
this� day of 201 �by this day of 20
(Name of person acknowledging) (Name o person acknowledging)
i
(Signature of Nota ublic-State of Florida) (Signature ry ublic-State of Florida )
`\\�SANY z"
Pe K own OR roduced Identification Personal( duced Identification
PrCZf.P elilic Type qN L ProduceI. �;�o + NCt l(q MHUF
Comm sslon#State of Florida eal Commission No. 90 dedmm FkP!e#F�234�
Co.m I? ` �Y Ce~ Xp1 3 730 ) ratio�May?�2�
Bondedthrou Y 27,2019 d1�'ot�y 019
9h Illation
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014