HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �' ��" I Permit Number: M45
Building Permit Application AUG I ? 9N','
Planning and Development Services PEW;;M 1-ii 1;;
Building and Code Regulation Division St. Lucie County, FL
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
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Address: s/►wo #VI5
Legal Description: k9l 1/57 h/2k—UNIF PT AW b6 Lo o�
Property Tax ID#: J����S�Q — ��UJ "� Lot No. Ll
Site Plan Name: Block No. O�
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work toe e orme under this permit—check a appy:
HVAC n Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric El Plumbing ❑Sprinklers 11 Generator 12 Roof s/a_- Roof pitch
Total Sq. Ft of Construction: (Ola S . Ft.of First Floor:
Cost of Construction:$ 19 Utilities:]Sewer El Septic Building Height:
C3WNR/L55E� P a a /+ .�
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Name 0 Ti4 Name: 'BEA 6AAJ
Addres : Company: .��N d / 77/
City: gr W C State:fL Address: 661 ��U��7� 1V1P k Ya 0
Zip Code: p /— Fax: City:ll'C0�OT 4W16— State: CL
Phone No. a r 9�0 �vr �� Zip Code:{����� Fax: 772-?33.S' /s5-#
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: 11
from the Owner listed above) State or County License: mO'3CQ,f/
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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.
St. Lucie County makes no representation that is granting a permit will authorize thepermit 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 fa'lure to Record a Notice of Commencement may result in your paying twice for
improvements to your propert A Notice of Commencement must be recorded and posted on the jobsite
before the first in pecti f •o intend to obtain financing, consult with lender or an attorney before
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en ' wor or r r ' ur Notice of Commencemen
s
Sign ture ;of Own ss e/Contr to as A nt for Owner Signature of Contractor/L cense der
STATE 0 -FiCOUNTY OF A 5T L��/� STATE OF FLORIDA � /I /�
COUNTY OF
The forgo' instrumppi was acknowledge fore me The forg�oi instrum nt was acknowledged before me
this/ d y of '7 20 by this�S 'dey of 20 /7 by
1 -NTO CAUT 3 radffnL
(Name of person ackno (Name of person ackno dgi
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( ignature of Nota ubic-State of Florida) (Signature of Notary P I c-Sta a of Florida)
Personally Known OR Prj�d�yced Identification X Personally Known X OR Produced Identification
Type of Identification-Produced l; r OL77(3-yg- �U Type of Identification Produced
Commission No.FM? �3 I mission No.
° Notary Public State of FWWa �vrRr Notary Public Siete of Florida
a I Sim
My Commission FF 981331 My Commission FF 981331
Revised 07/15/2014 u.a
Expiresosn9l2o20 o�n Expires 05/18/2020
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