HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
CC)UNTY``
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential A
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION'
Address: Vii WUL'STK h ('ALIS, L.OfMT STS .-UC/;E/ /., 3Ci 9 52
Legal Description: ZI 34 40 ALC THfi•T AAT ZyIN(f- Aw t W of ST. Wcie KNff AND Wok' L&L-I £SS ASN p� 251113 t2;�63-
Z436:-'S70-2923'.=S-274$:2SPI(-W1:27$L-2853-3136--Tl; 3i o3S�;316/-1'11;31cd-11N:3�8a-Z31Y-�2/7.`IYAC-9.5a�iX �
(o K 254- 10110 ?AIS )
Property Tax Id #: 3�1z'1 - I11 0002 - 000-- Lot No.
Site Plan Name:
Project Name: A 7? ,b
Setbacks Front Back:
-�-
�e C S4 --r i �s
U Plumbing
Total Sq. Ft of Construction:
Right Side: Left Side:
❑Sprinklers
Cost of Construction: $ S 100 . OU
Name rpt,#btT,0071
Address: M Nuez*(-ocoaw_ Ltd .
City: &<-t )-uCk-
Zip Code: �►`'j�_ Fax:
Phone No. dol --7T5 - g�53
E -Mail:
Block No.
3. S ToN 1 f� SPS10 4<\ LL/
[] Generator
SFt. of First Floor:
Utilities:11Sewer []Septic
State:�L'
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Windows/Doors
Roof
Building Height:
Roof pitch
I
CONTRACTOR:
Name:-D��_l1 t 1>
Company:
S e - AC Se�-QtC�_ , LI`C
Address: 53`'a nFCO MP_rrac)4-,. LP i L X11I
City: ptwT S� . u. � State: f�i--
Zip Code: Ug(p Fax: 1-2a -19314 -35 )I
Phone No. -7%a -g?1 - l SCID
E-Mail:S)9166.0 70vC S(>-1'-QICSLQ e(W-41L�C{ 7r
State or County License: Oy011 .l � 1
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL. CC3fiCT>,
y: ;
DESIGNER/ENGINEER: _ _No t App icable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zip: Phone:
N-I,V1^ R+1AQUYi
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
_ Not Applicable
State:
Not Applicable
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
commencin.g-bDTl-or recordin�ur Notice of Commencement
s
_ Signature of Owner/ Lessee/Agent Signature of ontractor/License Holder
STATE COUNTOY OF FLORIDA,-`�� S_ k r L L(' :l C
The forgoing instrument was acknowledged before me
this 1`� day of Hat/ 20 Q by
(Name of person acknowledging )
STATE OF FLORIDT I– S4 1, k� j e
COUNTY OF
The forgoing instrument was acknowledged before me
this )I day of ►'(CLu/ 20 by
_2)Ca \� ( 0 P) I r) �l
(Name of person acknowledging )
/
(Signature of Notary Public- State of Florida) ( Ig ature of Notary Public- State of Florida )
Personally Known '� OR Produced Identification Personally Known I/ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Pu
Commission No. LINf"ARIE BOUCHARID Commission No. •`: i 4NDA MAi E4ibUCHARD
• MY COMMISSION #FF125526 j• MY COMMISSION #FF125528
E)(PIRE. 1 —XPIRES;fj._f9lq ,P�
• "r.,7 , os n.,, Niay, v
Revised 07/15/2014 (407) 398.0153 FlorldallotaryService.com la07i 398-0153 Floridallotaryservice.com
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