HomeMy WebLinkAbout1707-0574 (2) i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: j�,01;.4,��'d
Building Permit Application
Planning and development Services
Building and Code Regulation division
2300 Virginia Avenue,Fart 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: i Crt 1 k
Legal Description:
Property Tax ID M � Q 0&/ _7 Lot No. j
Site Pian Name: Block No.
Project Name:
i�
Setbacks Front Back: Right Side: left Side:
D�'AIIED:DESCRiPTION OF WORK:
CaN5TR:UCTI�N INEC}RMATION:`: . .
Additional work torme un er s perms —check a apply:
HVAC 1JGas Tank ❑Gas Piping _Shutters Windows/Doors
C3Electric Plumbing 13Sprinkiers Q Generator �..1 Roof Q Roof pitch
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ Utilities:M Sewer 1:1 Septic Building Height:
OWNERAESSEE: CU►NTRACTOR:.. tt
Name ` Name: ccc��n
Address: Company: (A (Q(A I.a�_{ Cbz
City: g- State:EL Address: Inn Ga . 1Ci,45-, E~
Zip Code: 3 tf In'i 8 Fax: City: Sz-�- �rPc._. ._ State:
Phone No.-77r?, —',g Qd Zip Code: 3y q�P Fax:
E-Mail: Phone No.'-7-7a-c��2 -
Fill in fee simple Title Holder on next page(If different E-Mail;
from the Owner listed above) State or County License: 040 Z6.(-,
If value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.
SUPPLEMENTA!CONSTRUCTION`UEN tAW INFORMATION,
v.
DESIGNER ENGINEER: __Not Applicable MORTGAGE COMPANY: __Not Applicable
Name: Name:
Address: Address:
City: State: City: I State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TiTLE HOLDER: Not Applicable BONDING COMPANY: _iNot Applicable
Name: Name:
Address: Address: !
City: City:
Zip: Phone: Zip: Phone:
I
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 ermit holder to build the subject structure
Sthhu is in conflict with anyY pplicable Home Owners Association rules,bylaws or an covenants that may restrict or prohibit such
structure.Please consult wit your Home Owners Association and review your deed 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,wails,signs,screen rooms and accessory uses to another non-residential use l
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.
�ILL L. =-, s
Signal re of Owner L ss a ontractor as Agent for Owner Si na ure of Contractor Li nse Holder
STATE OF f1OMDA STATE OF FLORID
COUNTY OF 46`4 .L . (_.c��� COUNTY OF
i
The forgoing instrument was acknowledged before me The forgoing Instrument1was acknowledged before me
this L day of C � 20 Eby this L day of --�1, ,20 1-7 by
1 !
(Name of person acknowi dging) (Name of person acknowled Ing)
I 'E
(Signature of Notary Public-State of Florida j (Signature of Notary Public-State of Florida}
Personally Known__j___0R Produced Identification Personally Known ✓' OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. CXc,�r tit? __!Seal - _
•�•„ ►y GABRIELLE HICKS,
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Revised 07/15/20 i '�I iuly COiriMISS ON g i00 469447 x aa+d tEXPIRES:
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N�iuit"
REVIEWS FR 1 PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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