HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE
-INFO MUST BE COMPLETED FOR APPLICATION(T0 BE ACCEPTED
Date: ' I ' Q Permit Number: Lt�
y: a RECEIVED
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Building Permit Application DEC 0 7 2016
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County. 71U. "
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 I(V1PR01%EM1=NT LOCATION „y •
Address: 410 l � '?We_'/G'2 1 Q/^•
Legal Description:
Property Tax ID#: SvU `r90a,f —DDD- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
77777777771
DETAILED DESCRIPTION`OF WORC{ t
all
CONSTRUCTIC?`N INFORMATION to x
,S
Additional work to be nertormed un ert ispermit-c ec a appy:
FIH Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
_Electric ElPlumbing Sprinklers E Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ /Di/ UtilitiesIn Sewer OSeptic Building Height:
�SNNER/LESSEE ,�w1CONTRACTOR.
Name if/iC 2� /� aS� Name: �' ' ,rbc►/ {c�•.o/o ,%'
Address: D .41. Company: ��d�/-�/��i�rCGI 1�' ��•�� o.g�-e
City: !/C,a State: `� Address: /'9/D AIIJ e/VI-A -fl-
Zip Code: Fax: City: 0J1%r2a,,o Aeg a State:��-
Phone No. Zip Code: g-qb 6 c-� Fax:
E-Mail: Phone No. 9W__2A*J ” 9d9D
Fill in fee simple Title Holder on next page(if different E-Mail: Gv,/! eV-S" 0wal/ag,d /-0141
from the Owner listed above) State or County License: !!�_('7�Kl?zy
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPFLEIVIENTAI,EONSTRUCTIQN LILW INFQRMATIQN16
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: -City: State:
Zip: Phone: Zipr: 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 an 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. of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTYOF J6DWGyf
The forgoing instri.Lment was acknowledged before me The forgoing instrument was acknowledged before me
this 11L day of 20 JL,�y this —1 day of &reM he, 20/kby
(Name of person acknowledging) (Name of person acknowledging)
�-
(Signature of Nota Public-State of Fl )rida) (Signature o otary7OR
tate of Florida
w )
Personally Known OR Produced Identification Personally Knon Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. ' _'' "" ` JEAtg )STEWARD
AREN S. NIELS N o fission No. r o:
�`'pY vuB%�- Commission# FF 1 t 5637 _ MY COMMISSION#FF011507
'. ion Exp fes � �°� EXPIRES April 24,2017
�°' June 12, 2018 (4071 153 FIOMMNOWYOervice.com
Revised 07/15/2014OF
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