HomeMy WebLinkAboutBuilding Permit Application u�
' ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _
Date:
C�' l�Y Permit Number: C21 o O
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Building Permit Application SEP 0 7 2016
Planning and Development Services PER[-.glTTliq'G
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
IRQPosEo � PovluT LocATION ,.,
Address: 32—yo S V ksy"ey Leo,_t 3
Legal Description:
Property Tax ID#: �02 6 D �• 0 D nLot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
dETAILED DESCRIPTIfNtOF WQRK
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C}NSTRUCT }N INFO`RMATIO'`Nh
_
Additionalwork tobe[,er orme under this permit check a appy:
HVAC GasTank ❑Gas Piping _Shutters Q Windows/Doors
L!1 Electric 0 Plumbing Sprinklers E Generator 1:1 Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
00
Cost of Construction:$ 02 °°� Utilities: _Sewer 0 Septic Building Height:
£)WNER LESSEE
/ � ACTUR
CONTR �;
Name W ihalson ci 4G'G Name: IeUj
Address: 17 6-ID -S Company: '
City: 6/vt)Al�el t7�� S, State:P-Jr Address: m y/fitf "M
Zip Code:_gg3a2, Fax. City:_ , �c tp�'GG Stater
Phone No. 2' Zip Code: 2��y7 Fax:
E-Mail °772--Z/9 `22-9f i
Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: n
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
UPPIEMENTAL -"T-0 ''ISN I.AW INFRMATIUN:
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.
Signature of wnr/ gent/ ssee Signature of ontr cto /Li n Holder
STATE O FLORIDA STATE OF FLORI
COUNTY OF "-I kLici2 COUNTY OF ',:Z�-. ( I I
The forgoing instrurqent was acknowledged before me The forgoing instrument was acknowledged before me
this DQ_a day of 20 6 by this sE day of , 4M,-- 20-4 by
McJnnl L,oAJQ�- M U nn , L_oL.uro'.
(Name of person acknowledging) (Name of person acknowledging)
_(�--RawA-flqaA,/L, r 4n j I AD �MGAA'
(SigKature of Notary Public-State of Florida) u of Notary Public-State of Florida010
)
Personally Know �' Personally Known ro uce j% n24i
Type of Identifica 0R.fp'fd cid L�It3gMANN Type of Identification r�s Notary Public-State of Floridaomm. ps A r 24,2018 • c My Com ExpQCommission No. p Commission No. =� ` Com MIN,� ow, Commission#FF 094692 �'%: °'�� Bonded Through N
Through National Notary Assn.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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