HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE IN MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1" 0, 4-
" Q 4_ Q t l
Date: -1 "' I Permit Number: I. _ I I
- .m '
APP 10 201
Building Permit Application PER"SITTING
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
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 IMPROVEMENT LOCATION:
Address: Z p- S t 3 b
Legal Description: (Le_SerfJe_ Vw�c�u d L4±:
Property Tax ID#: ,SSZ.1 TO, 001S000% Lot No. _
Site.Plan Name: 0M..0--ra ?-as i �cBlock No.
Project Name: ISS A enc,,_
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
5/ �
CONSTRUCTION INFORMATION:
Additional work toe nerformed under this permit-check a appy:
HVAC Gas Tank ❑Gas Piping _Shutters windows/Doors
FlElectric 0 Plumbing Sprinklers ElGenerator E] Roof Roof pitch
Total Sq.Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ �"To C), Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
NamelJi' i ; o Name: f f!s
Address: /1 Q4 Zx C GS.e Company: L �ljeC5 [hr+P
city:eo r�'- State. Address: 32-31 5E b&1Ju'.n1 Lk
Zip Code: Fax: city:rtS fi1c��- State:
Phone No. 7-q Z TOq Zip Code: .3�-l�`l'7 Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: C t.7(`1'(_ c&6L;,laoG5 C-a m
from the Owner listed above) State or County License: ';L-c- Z,; 663
Ln�rc_ SD el- 19
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: Not Applicable BONDING COMPANY: of 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.
s
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 00-1(t,('11 COUNTY OF to M("I) )
The forgoing instrument was acknowledged before me The forgping instrument was acknowledged before me
this'd day of ftir i 1 , 201-7 by this day of OP 1' I ,20 by
�ucholn
(Name of person acknowledging) (Name of person acknowledging)
(Sign ure of Notary Public-State of Florida) ( gnature of Notary Public to of Florida)
Personally Known OR Produced Identification Personally Known � OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. f3) U3 (Seal) Commission No. (Seal)
SHAW NA M.HODG
SHAWNA M.HODGE
KIM
STATE OF FLORIDA NOTARY PUBLIC
Revised 07/15/2014 Comm#FF131836 STATE OF FLORIDA
ma 6/1112013 Corms#FF131836
ires 6/1112018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS