HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11- ILD-I& Permit Number: 9z
7--�7
NOV f
Building Permit Application d X016
016
Planning and Development Services P E R P11 I-ITi 1\1 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
PROPOSE 0 P_JM_ ,PRbVE _ME
NTLOCATION
- ';
Address: :7(o03 P4 C X;C ,5,J Lc Le d
Legal Description:
Property Tax lD#: 13G I6 6,00q Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED.,DESCRIPTIO,MOF WORK:.
L;ka 4&r L, 7_,,N 1 .5ee Ak c'KcA5,ow Jr, Keck
CONSTRUCTIOU INFORMATION:,�.'4�.
Additional work to be nertormed under this permit-check all apply:
2HVAC Gas Tank ❑Gas Piping Shutters ❑Windows/Doors
❑Electric ❑Plumbing 05prinklers OGenerator ❑ Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ a Utilities:[]Sewer E]Septic Building Height:
CONTRACTOR:
CTOR:
Name / pz;*� SctAe,4 Name: PAAof%J6&;1% Are 4t-C
Address: Company:
City: r-r i ev 0 State:_Fl Address:
Zip Code: 3�6_4 Fax: city: Vero ger_eh State:_R
Phone No. -1 q Z- 33Z- 1?6-ro Zip Code: 37,9(&0 Fax: :11 Z- 901-53cl
E-Mail: Phone No. -11 Z- C1 Yo' 9995
Fill in fee simple Title Holder on next page if different E-Mail: 3-ft1ze_rWW_o4vAC& &ACkr,0 . ca^
from the Owner listed above) State or County License: &
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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.
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_Signat re of wner/Lessee/Agent Signature,6f C tractor/License Holder
STATE OF FLORIDA _ STATE OF FLORIDA
COUNTY OF SI L ic-a COUNTY OF 5'r L,c-e
The forgoing instrument was acknowledged before me The forgoing instrument`was acknowledged before me
this Ir day of 6.bSLCAnnbxxr , 20 Eby this�day of t40 VCmk)� .20 �by
(Name of per on acknowledging) (Name of persbh acknowledging)
(Signature of Notary Public-State dVFlorida) (Signature of Notary Public-State of Ff8rida)
Personally Known ` OR Produced Identification Personally Knowny OR Produced Identification
Type of Identification Pro Type of Identification Produced
MELISSA A. LONG MELIS LONG
Rl�y
Commission No. _°�� B`'�'= C4Ssion# FF 52114 omission No. .� . Commis AV' 52114
MIm
_.
a� My Commission Expires 3s� = My Commission Expires
safe OF Ft°��� October 08, 2017 ''�''f°{F
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS