HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR-APPLICATION TO BE ACCEPTED
Date: —1 ' 1�• �� Permit Number: LJ
RECE a D
Building permit Application SEP 15 2017
Planning and Development Services PERMITTING
Building and Code Regulation Division- St. Lucie County, FL
1300 Virginia Avenue,Fort Pierce FL 34382 /
Phone:(772)462.1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description:
Property Tax ID#: "" Lot No. J�
Site Plan Name: Block No.
Project Name: S~ V_�-
Setbacks Front Back: Right Side: Left Side:
MEN=
({,-e. ' I(V..,e res td r)¢i a1 14 G ma =r r7
G 15A n )(0 6
t a wor toTIOrme under is perm —Peck HVAC GasTank ❑Gas Pipingrs Windows/Doors
Electric PlumbingSprinklers Generator Roof
Total Sq.Ft of Construction: / 5 Ft.of First Floor:
Cost of Construction:$• �' 6(/� � _ Utilities: Sewer Septic Building Height:
Namei � Name: � , h
Address: Company. r f `
City: • f
State: , Address: t r-
-
Zip Code: Fax y City: State:
Phone No. '7I Zip Code: Fax: Z
E-Mail; Phone No.
J(U11
Fill in fee simple Title Holder orlxt page(if different E-Mail:
from the Owner listed above) State or ounty License: 054A 9A0
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: -NotApplicable
Name: ..,......_.- Name:
Address- Address:
City: _ -- .- --_State: City: .State:
Zip._ Phone: Zip: --. Phone:
FEE SIMPLE TITLEHOLDER: _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 tp 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 OWNED:Your falilure3 to Record a Notice of Commencement may result in your paying twine 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 record' our Notice of Commencement.
s
_Signatu net/Le ee/Agent Sigont actor/License Holder
STAT ORIDA S17/OFFLORIDA
COUNTY OF " �-uc% COUNTY OF Sf Luc 1 ie,
The fo oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this r day of ` bC4AP-e/` . 20 �by this Jq-- day of r-a 20 _by
(Name of person acknowledging) (Name of person cknowledging)
LaL�G(.0 c.(a a. Mr �.., � a CX
(Signature of Notary Public-State of Florida) (Signature of Notary Publio-State of Florida)/
Personally Known✓OR Produced Identification Personally Known r OR Produced Identification
Type of Identification Produced Type of Identifiication•Produced
Commission No. 4)0'1Commission No. d s�„r^ ea
r11 IS11NA L LOUD E CK E
KRISTINA L LOUDER CK F*� `_' MY COMMISSIMN �2;:
°� �f 922` µ� EXPIRES August 7.2 7
Revised 07/15/2014 '� . XPIRS August 7.2017 (4 39&01s3 F7addatvot enlw.co
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407)398-0183' P10 daMataryServft.00rn --i
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