HomeMy WebLinkAboutBuilding Permit Application 12/28/2016 09:09 7724626448 SLC CODE COMP PAGE 05/06
ALL APPLICABLE INFO MUST BE COMPLETED FOR AVPLUTIDN TO BE ACCEPTED
Date 2 7(• ?A I o Permit Number:
RECEIVED
Building Permit Application DEC 2 8 2016
Ptnning and aevelapmentServices
Building and Code Regulation Divisfan PERMITTING
2-M Vlrginlor Avemie,Fort Pierce K3oW2 St. Lu • C nty, FL
Phone.(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: 7o Select from dropbox, click here
PROPOSED INPROVEMENT Lona :
w
Address:
Legal Description:
Property Tax ID#: r�,�,.:�,�C�D• (�t�7' QQ � _ Lot No.--?=Z.0
Site Plan Name Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAIL�Q pESCRIPTION OF WORK_
CONST UCTION INFORMATION:
Add
ttiona wor Orme un er is permit— e a aPp Y
❑hINAC OGas Tank ❑Gas Piping shutters Windows/Doors
11 Electric aplumbing Sprinklers Generator Roof
Total 5q.Ft of Construction: Ft.of First Floor;
Cost of Construction:$ UtilitiesSewer 13Septic Building Height:
OWNER/ SEE: CONTRA
Name Name:
Addr@ssQ1LJ1 21M Company:
City; stater Address.
Zip Code Fax: city: State:
Phone No. � Zip Cv e=. i�,� ��
E-MaSI: Phone No.
Fitt in fee simple Title Holder on next page(if different E-Mail: '
from the owner listed above) state or County License: S-, l
if rAue of oonstruction is$2500 or more,a RECORDED Notice of Commencement is required.
12/2812016 09:09 7724626448 SLC CODE COMP PAGE 06/06
SUPPLEMENTAL CONSTRUIC ION LIEN LAW INFORMATION:
DESiGNER/ENOINEER: _� Not Applica le MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City, State.
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: .,._„Not Applicable
Name: Name.•
Address: ,Address:
City
Zip: Rhone: Zip: .. Phow.
OWNER/C014TRACTOR AFFIDVi n Applic sUart Is hereby made to obtain a parmit to do the work and installation as indicated,
I certify that no work or installation has commenced prior to the Issuance of a permit
St.Lucie Coun makes no representation that is granting a parmit will authorize the mit holder to build the sublet#s ore
which is in wn ct with any applimbie Home wfiers Association rules,bylaws or and covenants that tray nMtrIct or pro i It such
structure.Please consult with your dome Owner$Association and review your deed for any'restrictions which may apply.
in consideration of the granting of this requested permit I do hereby sAree that t will,in all respects,perform the work
in accordance with the approved plans,the Florida 8uildfrig Codes and St.Lucle County Amendments.
The following but! Ing permit applications are exempt from undergoing a full concurrency review:room addtitons,
accessory strudukinrk
swimming pools,hedCes,walls,signs,screen rooms and aaesso uses to anathernon-resaderal use
UNARMING TOER:Your fel ure m Record a Notice of Com may result In your prong bilice for
improvementsur property A Notice of Commencement must be corded and costed cart the jobsite
before the firsection. If y Intend to obtain financing,consuhk tender or an rney before
commencin Wr recon ire otice 4 rnrnQttc%MepL
signature of owner/ L e tura of Cc" 0Mkikisellioldir
m =
STATE OF FLORID '- A'CE OF FLORI :.;,,,•
COUNTY OIC LINTY OF
The Ing"rsCru ted before e�� T e forgoing instr wa ckn d before me � '
this day 20 by r s day of z0 by
v r m
a47� v
m
(Name o at:krlowledgin } a e ( me of pe a owtedgtng) ra R
w
OR
3. o
r
(StaatCre of Nota Ilc-State of Florida} of Notary lie•Stene of Florida)
Persona ily Known OR Produced Identificatlan Personally Known OR Produced Identification
Type of Identification roduced Type of identificacio Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVLSOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW ReViEW RRVIEW REVIEW
DATE
RECEIVED
D t
COMPLIM13