HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:-M-1a. �(a Permit Number: I
..........
Building Permit Application OCT 2 S 2016
Planning and Development Services PER',I iITI'iN1-:1
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
:PROPOSED INIPROY EME, LOCATION ._.
Address: 10 C3 Lo _13 W19 713 l
Legal Description: [Z( � /�(/N�S CO�dD UNi T 7i3 1OY2 Z695!- Z.--?(o 1
Property Tax ID#: 4/5'/Z - 76 Z _ 06 24e ^ d200- -7 Lot No.
Site Plan Name: O2C.OLL 1\.I o Block No.
Project Name: _ -neo
Setbacks FrontBack: Right Side: Left Side:
DETANLED DR(PTIONOF WORKS
W'W) . �c N�S w,TF &i -101"
CONSTRUCTION (NFOR(171ATION
Additional work toe e orme under this permit-check a appy:
HVAC E]Gas Tank []Gas Piping Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 3(07 7 Utilities: Sewer Septic Building Height:
OWNER/LESS E CONI" 'AC
TCIR `
�.
�. _
Name EaC.QLArfVQIO nN Name: /
Address: 7 LSI Company: cN
City: MI&4-@t L GE lei' State: Address: /7& 4/w-aw%�
Zip Code: Fax: City: li��f71 fM.T State:r-:I-
Phone No. Zip Code: 1-f Fax: /q--2_ 7Y5!f
E-Mail: Phone No. ('_' Z —00go
Fill in fee simple Title Holder on next page(if different E-Mail: 46e OW/1,,6g�? �a
from the Owner listed above) State or County License: iie
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SyUPPLEMENTAL CQNSTR,UCTION LIEN`LAIN INQRMATI�N {
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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 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 fail re to Record a Notice of Commencement may result in your paying twice for
improvements to your pro r . A Notice of Commencement must be recorded nd posted on the jobsite
before the first inspe io I u intend to obtain financing, consult with I nd or an attorney before
commencing rk re r o Notice of Commence t.
A�
s
Signatlure of Owner/Lessee/ ontractor Agent o Owner Sign ure of Contr or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFCOUNTY OF �'r I—OC.��
The forgoi instrument was acknowledged before me The forgoin instrument was acknowledged before me
the of �_T 20f-by tlg�of e� 20/ by
(�20'0/ JI0
(Name of person acknowledging) (Name of person acknowledging)
(Signator Notary Public-State of Florida) (SignaturNAtary Public---St-ate of Florida)
Personally Known ✓ OR Produced Identification Personally Known '—_ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. .sY'ac-.. AJU*UMOND Commission No.
MY COMMISSION#FF 1737 ,,}"�" e _ ANN M.GAUMOND
EXPIRES:December 7,2018 s+: - :.= MY COMMISSION I FF 173907
u FAF�4 Bone ru o ary u c n envr ers s; �o ecember 7,2018
pF 1�,••` Bonded Thru Notary Public Underwriters
Revised 07/15/20
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS