HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
T,7,
Building Permit Application JUL
Planning and Development Services pERn;,1 t-�
Building and Code Regulation Division St. Lucie Counrly -L
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
PROPOSW IMPROVEMENT.LOCATIONs
Address: 5cA 13 IC3arxfA(tee Legal Description: t LQ�4 0w- 1 Q5 1 a- 3a tinAlan
Property Tax ID#: 31402Lpcl bOULI DSD 2 Lot No. 'F
Site Plan Name: _ Block No. Q3
Project Name:
Setbacks Front Back: Right Side: Left Side:
::DI LED.DESCR[PT[ON:OF.WORK:
Lit.5 70 LL- i I o' d f �P� lu 14 ,%e- PVC— ,I,y
z � t�rc CDN LcP� 5Ibv " - 10 is %3 vim- i2► c�c-ir 5 �c �5 � iws����
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CONSTRUCTION INFORMATION
ACIditional work oorme un er sperm -c ec a appy:
.CJHVAC rl Gas Tank ❑Gas Piping _Shutters a Windows/Doors
Electric Plumbing Sprinklers �- I Generator Q Roof Roof pitch
Total Sq.Ft of Construction: SO.Ft.of First Floor:
Cost of Construction:$ 79 0 Utilities:Sewer Septic Building Height:
OWNER/LESSEE
:CONTRACTOR:..
Name LDQ,,Jz6 L u - Name: Ma;k
Address: SA1 i3 c,;-ec�,:E�(-ar" 7��v� Company: R Qu,u;
City:� -�. ;:)ie� state:r L Address: IL15 Eck--
Zip Code::54ci$a - Fax: City: Stater
Phone No. 7-7a-UO$ �, C1(19 Zip Code:,-3q R 9Q Fax:
E-Mail: Phone No. 77a-05�2 -
Fill in fee simple Title Holder on next page(if different E-Mail:gC�,Q 1,b-� - .��@ Czm-i 1 CJe
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.
i
SUPP[:EMENTAL.CONSTRUCTiaN LIEN LAW INK RNiA 100
DESIGNER/ENGINEER: Not Applicable 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: City:
Zip: Phone: zip:_.__. Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
w Lucie County make no representation that is granting a permit Will authorize the permit holder to build the subject structure
w(iich is in con ict wit anYY ppilcabre Home Owners Association ruses,bylaws qr ancovenants that may restrict or prohlbtt such
structure.Please consult wit:your Home Owners Association and review your creed or 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 c> cS.. E • L�..c a COUNTY OF A L-
The fo,r, oing instrument was acknowledged before me The forgoing Instrument was acknowledged before me
this L .day of 20 i i by this )3 day of c,ZcA L4 '20 f7 by
3x,b6L,
(Name of person ackno ledging) (Name of person acknowl ging)
(Signature of Notary Public-State of Florida} (Signature of Notary Public-State of For a)
Personally Known�OR Produced Identification Personally Known ✓OR Produced identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
��;�j;'v,'Y.'.y GABRIELLE HICKS GABRIELLE HICKS
Revised 07!151201 -"J
MY COMMISSION#GG 069N7
_ MY COMMISSION 0690,
tom. EXPIRES:F 2.2021 f GG
�..°g,� 8"WW Tlw No '`.,,°;f;tg`° BaWed fJofarY
REVIEWS FRO PLANS VEGETATION
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS