HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEDQ
Date: C Permit Number: l 09 -(1
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Building Permit Application SEP 2 12017
Planning and Development Services
PERMITTIRi;
Building and Code Regulation Division St. Lucie Count;, 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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PROPOSED'IIVIP::ROVEMENT LOCATION.:,
Address: � s5 U r Rd R. 'Pia-e-0- -3 5-
Legal Description: OY_ ► ay-g-S - � tSk. _Ft-o - �?6LAS-53) L-01 314
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Property Tax ID#: I 12 SDIO 13 b DUD?
Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION QF WORK ¢x:
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CONSTRUCTLON INFORMATION
Additional work to b rtormed under this permit-check a t at.app y:4
HVAC Gas Tank ❑Gas Piping Z Shutters ❑Windows/Doors
11 Electric ❑ Plumbing Sprinklers M Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 8 Utilities: 0_Sewer O Septic Building Height: -
OWNER/LESEE ,CONTRACTOR:
Name Name:AQ._r %C,5 `,. I '�Is
Address: �11 z� s p�S h" Ek Lit- Company: Fbpkk c, Sr Ldkir-S I r)c,.
City: -rf7V'T Pl-e rc:t State: Address:_ S C
Zip Code:34gEI Fax:, 1 City: o ro !j2QC State:. .
PhoneNo. � 2) X32 �-1 3 Zip Code:AZgU() Fax: (3-T2)`Sk4-5U'7q
E-Mail: Phone No. 22Cj
Fill in fee simple Title Holder on next page(if different E-Mail: ��10C La&_'Sk-LL-kVS(hC -CO
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTIQN LIEN LAW INFORMATION:a
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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 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 y u intend to obtain fin racing, consult with lender or an attorney before
commencing work or recordinMyour Notice o mencement.
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ignature of Owner/Le e/Co Vractor as Agent for Ownerignature of Contractor/License Hof
STATE OF FLORIB#! STATE OF FLOR DA ^�
COUNTY OF c -1. .l�n i.�}� �� COUNTY OF
The forgVng instr ent was acknowledged_before me The for instrument was acknowledged before me
this day of 20 by this l day of ��� 20 ��by
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(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida-)-
Pe n ; own ro tification Personalty Known OR Produced Identification
Ty ation ?&kgMER Cly Type o I en ifi ti n Produced
S. NDUryPubtic- tate of Florida
Co a . Commission#FF 966942(Se 1) Comm ';� We;'., DEBORAH EMERICJKe
Met
yComm. p res ar 20,2020 �. . Notary Public State ofCommission a FF 96My Comm.Expires Mar 2
Revised 07/15/2014
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