HomeMy WebLinkAboutBuilding Permit Application�V'L-N
SL INFO COMPLETED FOR APPLICATION TO BE ACCEPTED
ALL APPLICA N
Date: Permit Numben.
E
KC 92 J, V ED
Building Permit Application MAY 10 2@17
Planning and Development Services
Building and Code Regulation Division P E R 1,411 TT I'MIG
St Lucie C nt)", FL
2300 Virginia Avenue, Fort Pierce FL 34982i '
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
[SRO s - 070#81
Address:
Legal Description: n I Im 17110 14-0— '.:3�11CIL c
Property Tax ID #: .3q10 -,Z-)3 _W0_9 - CIO() - Lot No.
Site Plan Name: Block No.
Project Name: C ri nQ +0 n
Setbacks Front Back: Right Side: Left Side:
ail 014 MR,
0: .0
ChC,�qe CIO()(,, no 3 i-ze- choly
01.
Aaclitionalworktoperierformed underthis permit — check all t= apply:
r"Tank F]Gas Piping HShutters Winclows/Rims—
1]HVAC ]
Gas
Electric 0 Plumbing OSprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
]Septic
Cost of Construction: $ Utilities: [—]Sewer[ Building Height:
*N_
N a rn e:
Name AAW) Q •1444_'-
Address: Sq5_1'_Fra. 11-e l 11J,-Av
Company."::�(o
Address:
City: --R'P C4, P State: L(,
Zip Code: _�Yol'r F
City: IL, J -'h k State: E�—
Phone Na. !21� ".- 4W
_ _q
4 -qQI Zip Code:3SLI I a--- Fax: 5 .
E -Mail:
Phone No.
Fill in fee simple Title Holder on next page (if different
E -Mail:
from the Owner listed above)
State or County License: C, 10
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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F3 p. 5 JR ;IGEN 1� A It�J�� 10 —A i10
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DESIGNER/ENGINEER: y,Not Applicable
..�}N rZ.�Yd.•
MORTGAGE COMPANY: i -I of Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: �ot Applicable
BONDING COMPANY: TNat 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
_Sign` tura of Owner/ Lessee/Agent .
STATE OF FLORIDA .
COUNTY OF ?', �l l
The for Ding instrument was acknowledged before me
this day of AP 20 / by
,;rte s
Sign#req'D
a of Contractor/License Holder
STATE OF FLORJ.DA
COUNTY OF ' ey-m
The forgoing instrument was acknowledged before me
this .T day of Pau 20 by
.1. I �n M es i)• �t U ( 5
(Name of person acknowledging) (Name of person acknowledging)
.rye►
Signature of Noti3ry'Pu ic- State o .F ori a
Personally Known Lam' OR Produced Identification
Type of Identification Produced
Commission No. Fr
Revised 07/15/2014 (407) 398-0153
of Notarf Public- 9'tate'of Florida )
Personally Known OR Produced Identification
Type of identification Produced 'I
(461RA MAE ROS HI fission No.
MY COMMISSION #FFO 6462
EXPIRES June 17, 2018
OF
ANGEt(��f G
ly COMM19ISSjj``0N 951069
EXPIRES Apel 12.2020
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETE
INITIALS