HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I� l l D,. 1)�J
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Building Permit Application DEC 0 6 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
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PR`OPO.SED,fNIPROVEMENT . -
Address: 2o0 Nu) O ild-et5 Ca�q_ejC (Z_A ���� C-�'�—/ 3`t��t'6
Legal Description: G" - D ne- ✓t ba'�'C Lo4
Property Tax ID#: L/Y Z 3 901 O DO 5 O0 D Y Lot No.�_
Site Plan Name: TaS ca e_a,sa,_ Block No.
Project Name: I _e �E&o 2
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPI ION OF WORK
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CONSTf2UCT1 -N INFORMATION
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Additionalwork toe performed under this permit-check a appy.
HVAC0 Gas Tank ❑Gas Piping _Shutters EIVindows/Doors
Electric 0 Plumbing Sprinklers E Generator 11 Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ ZZ Utilities:Sewer 0 Septic Building Height:
OWNER
/LESSEE ', CONTRACTOR TM s
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Name'�;�J C W"r 1ote- ..5 c'D Name: CLI S ✓ o-�
Address:ILDO OL-2 t�#Y`lfe45 L,,'4e_?e-k Company:Lb I; u, eC_5 C 0-A
City: Pyr'; Cfl+-4 State: Address:s?Z3) Sc= L)o^J- c2 7r- -l/'
Zip Code:.311 q 9 6 Fax: city: Sal vel� State:��-
Phone No. 3 3 6 Lori o Zip Code: 3L195 "7 Fax:
E-Mail: Phone No.7 L 2 ?Y ,-
Fill in fee simple Title Holder on next page(if different E-Mail: c_b K6-0,I c-0
from the Owner listed above) State or County License: 5c-Q Ls$6 3
C-C—C- 15-071LO
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: of Applicable MORTGAGE COMPANY: _ of Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Mot 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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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF MQdfi el COUNTY OF MCuOr /1
The forg8 /ing instrument was acknowledged before me The f ping instrument was acknowledged before me
thisW i day of hl Q✓G'M bt20 1+-by this day of JJLVCM k*-- 20 /(O by
C- T✓-tot CL.,-,/ �w fc., I-w
(Name of person acknowledging) (Name of person acknowledging)
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gnature of Notary Public- taffi of Florida) ignature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known `®�OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. F F 3(PMNOTARyPUBLIC
SHAWNA M.I omission No. If F 1.31 &.3 Zr (Seal gHgW�M ODGE
NOTARY PIJI IC
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Revised 07/15/2014 Expires 6/11/2018 Expires 6/11 018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS