HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 11 _ I
Date: ' I LoPermit Number: o�
RECEIVED
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• _ _
Building Permit Application AUG (l 1 2016
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County
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
PROPOSED IMPROVEMENT.LOCATION
Address: /� L
Legal Description: �b1 Or47yL �lVCW S' S l�74� C un, ✓ 4�—
Property Tax ID#: 3 �U9 dLo Gf 67 Lot No, J
Site Plan Name: -Tedd a , r, a�✓ Block No. �—
Project Name:
Setbacks Front Back: Right Side:: Left Side:
DETAILED DESCRIPTION OF WORK
0
CONSTRUCTION INFORMATION
Additional worK toa orme under this permit—c ec a appy..
HVAC 0Gas Tank [:]Gas'
Piping _Shutters EJWindows/Doors
11 Electric M Plumbing Sprinklers Generator FiRoof
Total Sq.Ft of Construction: -/ S� S .Ft of First Floor.
Cost of Construction:$ �J�� Utiliitiest Sewer Septic Building Height:
OWNER/LESSEE CONTRACTOR
Name e'1' fZLC.,,IIName: rs l C
Address: Ve 3 cL Company: / r CqV f1ArK bez L
City_ State•— Address: cce VCl�
ZipCode: 3i !4j�' Fax: ✓6 ss
City: 1_f 1�P '� State:
� J
Phone No. — 1 `l Zip Code: �� Fax:
E Mail: Phone No. 7
Fill in fee s' le Tide Holder on next page{if different E-Mail: K iyLcre U 4C1 /
from the Owner listed above) State or Coun "cense:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPIXM!!nA C0NSTRUCTI6N;LiERi1AW NFC3RMATtON,
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
State: city., State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name--
Address:
ame:Address• Address:
CftY' CW,
Tip: Phone: Zip: Phone:
I certify that no worst or installation has commenced prior to the issuance of a permit
SL Lucie Cou makes no represematian Lha#isgrartttng a perinIt wits authorize the permit hotter to btMd the subjectstructure
which is in coict with any apptpble Home owners Association rules,bylaws 4r 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 t will,in all respects,perform the work
In accordance with the approved plans,the Florida Building Codes and!St.Lucie County,Amendmerits.
The following bulldurg.permlt applications are exempt from undergoing a full concurrency review:room additions,
accessory strictures,swimming pools,fences,walls,sigum screen rooms and accessory uses to another non-residential use
WARNING 70 OWNER:Your fallure to Record a Notice of Cominenicement may result in your,ayirrg 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,cons with lender or an attorney before
commelleing worts or recordigg your Notice of Commencem
S
Signature of owner/Levee/Agern� �1� 1 meq, Signature of Contractor/License HolderPeiWal W 1 trin4 Ph �
STATE OF FLORIDA 1 �>/ STATE OF FLORIDA
TY
COUNOF , , tjo iF, COUNTY OF b,, ) •�s�('���.
The forgoing! stiMment acknowledged before me The forgoing t"meet wa•acknowledged before me. �
#Iris day of_ . 20Ut irythis day of 20 } by
(Name ofperson acknowledging) (Name of person acknowl ging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personalty Known OR Produced Identification
Type of Identification Produced G. , 4 3 6-Z;y4 --I�Q Type of identification Produced e
Commission No. ��:�,, N LS N. tnimission No. /
g� *c C mm ssion#FF 115637 : K S. IVlELSEN
�Q My Commission Expires , , Commission#-FF 135637
o 1 1 O ;
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Revised 07/15/20 , .lune 12, 2018
14.
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