HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: •I � _ Permit Number: Ile V'S C2
---(�l1 ,
MAY 12 2016
- _ Building Permit Application PERM11TTING
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)1462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
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PROPOSED fNPR01ElUIfANT LOCATIO„N ,? ..
Address: �►lU { � 4v�
Legal Uesc pti'on:
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Property Tax I #: 1fi 30/- 617 — 01,91 —I o(f)"-S� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE 'AILED D SERIRiffil OF WORK:
i�S��\ ince :�,��v- hti s��`o -�,b �Y��• 5'tia�✓ �'�a��t�
CONST'RIJCTION I�NF®Rtl\/! TI®:N: `� {� '�.
itiona wor to a pe orme un er t is permit—check all t at ap:p I y:
_ .. .
_.':IVlechanic{al _Gas Tank _'Gas Piping �+Shutters Windows/Doors
Electric; i/Plumbing _Sprinklers !' Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Constr fiction: $ )FCn Utilities: —Sewer V/Septic Building Height:
011VNER/LESSEE: `CONTprSIVAgal__RA1'OR
_,
NameCSC- L.i Name: fir.
Address:& Company: v- QLA
�r�,
City:F(�— pe trL.� State Address:'�7giS 1 � C� 1
Zip Code �� Fax: City: �'- ��fL� State. �
Phone No.7*i 3L�I .-.� � Zip Code:3!`Q5_ If Fax:
E-Mail: Phone No L/5—�l
Fill in fee simple Title Holder on next page (if different E-Mail c E kn . V1(
from the Owner listed above) State or County License '
Evalue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUI�'P�LEIUIsENTAL C�NSTftJCTtON L#fEN 1N 1N'FORIVIATfON: IN
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
o m ci workoi-\r0cording your Notice of Commencement.
,1nature of Owner. essee/Co or as Agent frjf}E Iture of Contractor/License older
STATE OF FLORID
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TATE OF FLORID Aq�' ;°
COUNTY OF COUNTY OF
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The forgoing instrument was acknowledged before �o c The fQr oing instrument was acknowledged bef a x o
this day of 20 j by �N this / day of 20A by nN
Saco
age
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72
a
(Name of person acAnowledging) L19
� (Name of person ac owledging) �N
J N N
PAin* &D
(Signature of Ubtary Public-State of lorida) (Signature of N ary Public-State of Flo da)
Personally,K own OR Produced Identification `/ Personally Known OR Produced Identification
Type of Identi tion Type of Identific i
Produced Produced C ,
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW . REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014