HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l M. I 1 Permit Number: in ~ c)12
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Building Permit Application OCT 17 2016
Planning and Development Services PJER;diITTiNG
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: L>\ L
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Address: ��6�1 lQOUI�� AXI Zneii A 64er Z F/__ "321
Legal Description:
Property Tax ID#: �`–I�` CC) • con Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION�yDF WORK
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CQNSTRUCTIOI,INFORMATION �#
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Additional work to be pertormed under this permit–check all that appy:
_//Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
.✓ Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ .550-00 Utilities: —Sewer —Septic Building Height:
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OW3IVER/LESSEE Y y CONTR ACTQR
Name ° Name: //
Address: /q31 oyt9L h9b 1>ri�/P_ Company: s LL
City: For-t Pu- r c e State: Address: e�
Zip Code: 349%1– Fax: City: � yifdytr�,G1`� State:
Phone No._5 6, W– 7 r-75 –)??, Zip Code: 3 3q_3 9 Fax:
E-Mail: Phone No 6-41 752 9,:U
Fill in fee simple Title Holder on next page(if different E-Mail�1 0 le'5 ca' (4o� cow
from the Owner listed above) State or County License UG ,/1®09 UP-
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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StJ�PPLEM�NTAL�CONS��'R4tJCTt,ON I.If�N LAtN IN�F®R.M�►T•IO.N.
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 thepermit 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.
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Signature of Owner/Lessee/Contractor as Age Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF a,OA-12— COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrume t was acknowledged before me
this -of 0C (261P�Q� 20 16 by this day of N 20fj�q_ by
(Name of person acknowledging) (Name of person acknowledging)
1th AA P aj=!�Q
(Signature of Notary Public-St (Signature of Notary Pu
Personally Known L/ OR Produced Identification Personally Known n--�OR Produced Identification
Type of Identification Type of Identification
Produced roduced ,.,�°�?a`'�"�%a'�••", UBENS DANTILUS
JEAN RUBENS DANTILU MY !1or
MISSIONFF054972
L `�_, Ic �.Commission No.. DcJ Vc ' MW@�I�MISSION FF05497 ommission No. �$`W,°:' Ekazd tober5.2017
EXPIRES October 5.2017rY Iap71328rQ153. allota Service.com
(40�)
398-0153 ori __
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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