HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED - 0 �
Date: Permit Number:
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RECEIVED
Building Permit Application NOV 2' 3 2016
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
,PROrPOSED IIVIPR01lEMENT LQCATIC3N
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Address: Ii;Zhn .S to Ma � S-1 O
Legal Description: i f p'--W90 jt Or, rt O Uwn(tl
iN c �vuD� Q�- �Ts /0►2 �50
Property Tax ID#: y 5 I I♦ - I1 - Dt�s 1 - 7 Z Lot No.
Site Plan Name: -'RA-4Pf0Lw& Block No.
Project Name: A-4-4 (-)y vi--
SetbacksFront 1{t Back: I�1/� Right Side: N��Left Side:
DETAILED QES'CRIrPTI`0—NC1F WORIC�. µ
CONSTRUCTION INFORMATION - „
Additional work toe e orme under this permit-check a appy:
❑HVAC E]Gas Tank ❑Gas Piping _Shutters 1llindows/Doors
11 Electric ❑ Plumbing ❑Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 2 L(0y Utilities:cn Sewer❑Septic Building Height:
OWNER/LESSEE O NTRACT0,
Name tU n me: KA t N 6a)Q1,S2,rJ
Address: louoo s [ 7 ► 1/E "* S/d ompany: _S&-5EQ -9E)91izE- !A1L4M'NutM
City: -J&-Sew �@ - State:_ Address: Q Z�-z VZ-DcTL4,t_ H%J-y
Zip Code: 3 �►r 7 Fax: City: ATL-f— State:IF
Phone No. V5.1 — (219$ Zip Code: 3Lf 9.y Fax: �`I'Z -q 7 c!Y
E-Mail: Phone No. 7`7-Z - X12- Du moi'o
Fill in fee simple Title Holder on next page(if different E-Mail: AIA Lc. w
from the Owner listed above) State or County License: i16 C 11-D54-3 :2
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CQNSTR_UCTION LIEN LAIN (NFORMATIQN
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 no sidential use,
WARNING TO OWNER:Yo r fa' r to Record a Notice of Commencement m y resul n yo p ing twice for
imp�velts your p per y A Notice of Commencement mus a rded nd d on thejobsite
befrs spect' n. I u intend to obtain financing, con It w end or a orney before
co rk or co our Notice of Commenceme
s
natfjre of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �S,i X-Oif,l,,ar COUNTY OF f3= Z IJr1,Z-
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thi,,,?L�ay of t24</ 20/�by thi &-'Jay of 1-)A 20,�_by
(Name of person acknowle ging) (Name of person acknowledging)
(Signature o Notary,Public-State of Florida) (Signatur otary Pub ic-State of Florida)
Personally Known bl/ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Commission No.
��14•��""••°y ANN M.GAUMOND ANN M.GAUMOND
'�,(�i
MY COMMISSION#FF 173907k4y COMMISSION A,FF 1739
Bonded Thru Notary underwriters
'� EXPIRES:December 7,2018
Rf ry h gf�°T' Bonded Th,
Notary Public Underwr tars
Revised 07/15/201
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