HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: %05'dajq
RECEP.'^D MAY 15 7.096 E �; �'
"k, id
Building Permit Application JUN 0 T 20%
b �� PERMI!'rfitlG
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: To Select from dropbox, click arrow at the end of line Shu-�e,r
PROPOSED IMPROVEMENT LOCATION:
Address: r W GIS Or'
. q— I✓re.
Legal Description: bf-U Mt &0J_h ,- Qe_CA1 'L U u U,—
PropertyTax ID#: 1 g2i,5 ' I Gt - 00121-,000 Lot No.�
Site Plan Name: Block No._
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION `OF WORK:
r cv1(Lu, P& -0 r Yy) aAAq o o 4
�-t�c-�r i ct� P�rm►� � a �,�;
CONSTRUCTION INFORMATION
Additional work to be nertormed under t ispermit—check a [napply:
HVAC Gas Tank ❑Gas Piping Shutters Q Windows/Doors
11 Electric ❑Plumbing OSprinklers Generator 0 Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ Z�l Z �� Utilities:cnSewer[]Septic Building Height:
OWNER/LESSEE:
CONTRACTOR
Name k arn Cox r Name: 70Gh 'r
Address: JAq 6ey-M U CI Ch VY Company:_19- A L� I
City: I�9'(,� 0— State:�L Address: 3LOX A(V -,hb
Zip Code:?�Liq l4q Fax: City:NJM f 11.h Stater^m
Phone No. Zip Code: -?JU b Fax.—MQqQ
E-Mail: Phone No. -ii i,c1clel L
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State otu
nty License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINE % Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: =4 City: State:
Zip: Phone: '1'12 ^l 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 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
commencing work or recording our Notice of Commencement.
s
_Signature of ner/.Lessee/Agent
i nature of Contractor/License Ho e
STATE O .FLOR DA�/ STATE OF FL RIDA
COUNTY OF �YI 1hfl� 'ye'y COUNTY OF V1 QI
The forgoing instrum nt was acknowledged before me The forgoing instrument was acknowledged before me
this )1 day of 20 16 by this day of 20 LLp by
(Name of person acknowledging) (Warne of person acknowledging)
en AA t?
�i
ignature of Notary Public-State of Florida) (Sinature of Nory Public-State of Florida)
Personally Known ,,/OR Produced Identification Personally Known N/ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.���'L77Z,1 (Seal) Sarah Ann Cumommission No.ft�-'rcj 2—n (�An PUBLICumCS
NOTARY PUBLI STATE OF FLORIDA
Revised 07/15/2014Comm#FF927731 Expires 10/14/2019
Expires 10/14/2019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS