HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `
Date: I I S ' tP Permit Number: `
m
, - - :- RECEIVED
Building Permit Application NOV 2 3 2015
Planning and Development Services PERMITTING
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`IM,PROVEMENT LOCATI„tN„
Address: 'S to b
Legal Description: 0Y,6 ,A- Si-`rt-,A cargo 1r (/N kT— 6010 01' Us)ok✓
—M`
Property Tax ID#: Al 5-11 — 51Z -Co67— oou —S- Lot No.
Site Plan Name: KA_i►0. Block No.
Project Name: I�7Zt M
Setbacks Front �l� Back:�Right SideN Left Sider
DETAILED DESCRIPTION SOF WORK
CONSTRUCTION INFQRM' lQN
Additional worto e e orme under c er t is permit— eck a appy:
❑HVAC fl Gas Tank ❑Gas Piping _Shutters �
Windows/Doors
❑Electric ❑ Plumbing Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
OJ
Cost of Construction:$�I�,�.n� Utilities: _Sewer O Septic Building Height:
,°OWNER/LESSEE =: CQNTRACTOR
.. . _ ,
Name AA &-_r1+ NV AStpany:
e:
Address: ((Yarn 5 ?0C9 aQ D12— 46610 ,��s F
City: 7&4_<9y State:_�— Address:
Zip Code: 3 (mCl Fax: City: ShZAfdA— State:
Phone No. Zip Code: 3 g9Li Fax: /� q 2
E-Mail: Phone No. 7'12 — 07'2-0010
Fill in fee simple Title Holder on next page (if different E-Mail: 114 141 t76#
from the Owner listed above) State or County License: / 019!L
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 p ying twice for
improvements to your prop . A tic of Commencement must be r ded drld on the jobsite
before the first inspect- n. If u i end to obtain financing, consult nd orrney before
commencing-wor or r c rd' r Notice of Commencement.
s
Signature ci ner/Lessee/Cont ctor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFA r A/_9('/F= COUNTY OF 7—
The
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this,?�E'day of 491)1,1 20/,,/,_by this>Z/`Sday of ��/7� 20/1 by
Z__
(Name of person acknowledging) (Name of person acknowledging)
(Signature- Notary Public-State o F orida) (Signature -Votary Public-State o-T�Florlda)
Personally Known � OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Commission No.
'giw`•??y''% ANN M.GAUMONDY'P ANN M.GAUMOND
+= MY COMMISSION#FF 173907 ;?��' yepMY COMMISSION 9 FF 17
t T EXPIRES:December 7,2018 , a EXPIRES:December 7,2018
o Q.•`' Bonded Thru Notary Public Underwriters of n�°`° Bonded Thru Notary Public Underwriters
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS