HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ur /�V n I
- -; RECEIVL
= - - AUG 0 3 2016
Building Permit Application
Planning and Development Services PER;JiIT'rING
Building and Code Regulation Division St. Lucie County, FL
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
PROPOSEDj,IMP.ROVEMENT LOCATION.
Address: Wi o�5 i�)uchawn '-C� Q
Legal Description: rt (x,11 19 I\(t°11' 5 �� `�1� "' (-)q —�1 1 M 1
Property Tax ID#: ",`-f�2"LD��i—!�0 .' l'� Lot No.
Site Plan Name: Block No. -
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:.
UcC� Cd EATU "`^C
:CONSTRUCTION,INFORMATION _
Additional work to be rtormed under this permit—check all appy:
HVAC LI Gas Tank ❑Gas Piping _Shutters a Windows/Doors
11 Electric F]Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ Utilities. Sewer ElSeptic Building Height:
QW, NER/LESSEE r , CONTRACI'QR h
Name Y- Name: hL
Address: U I()q Sw 22 'C";I Company: n
City: R)y-}- LQu teyd( c State: FL Address: �CS— n S
Zip Code: 33a (� Fax: City: � _+ .Y�ln�l t�C/l� Stater
Phone No. ��Z C��!�� bq b9 Zip Code: c349 Fax:
e
E-Mail: SSM (.AdPOO , CO Phone No. ( -)_)2� 2 W=1 Su--)
Fill in fee simple Title Holder on next page(if different E-Mail:X1(1&n+Ckl'QU C0nc,+(LLC+(W A11�G�t�•C
from the Owner listed above) State or County License: 0,(-'.CC(-133OWn
C_6C 12Sz1_ic)9
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
-4 117 >S99
�SUPPLEMENTAL.CONSTRUCTION LIEN,LAW INFORMATION:
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:
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 Owner/Lessee/Agent Signature of Contra- or/License Holder
STATE OF FLORIDA STATE OF FLORIDAS�
COUNTY OF �_ L1�C12 COUNTY OF
The rgoing instr ment was cknowledged before me The forgoing instr ment was cknowledge�l before me
this day of 20 ��Qby thisp� day of 20 Ap by
�� D M)fs4pn
(Name of person acknowledging) (Name of person acknowledging)
�M� Ubh�n &Qbu lihta)n
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known ,✓ OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Produced Type of Identification Produced
<'04!"'"'m4: BABA WATS ARA WATSON
Commission No. (S Eb mission No.
MY COMMISSION#FF15 600 MY COMMISSION#FF15560
EXPIR
EXPIRES August
S Auaust 28.20%
i�. '
o;=
Revised 07/15/2014 (407)398.0153 F(orldallotaryService.com (407)398-0153 FloddallotaryService.cam
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS