HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: O 2 I Permit Number:
Building Permit Application OCT 0 2 2W7
Planning and Development Services PERMI'l-1 WG
Building and Code Regulation Division St.Lucie County: FL
2300 Virginia Avenue,Fort Pierci Ft 34982
Phone:(772)462-1553 Fax:'(772)462-1578 Commerciai Residential_ Y
PERMIT APPLICATION FOR: To Select from dropbox,click arrow`at the end of-line
Address: �`?I D c,la�
Legal Description:�grjo ici h p ��n r''Cl c J e Twa ( Pa 43-33/
Legal
vlsnr 0?7112)
Property Tax ID#: 1 1 :S-D�2 - a De? �-paw -� Lot No. 7
Site Plan Name: )) Block No.
Project Name: cf Ir 6 h
Setbacks Front Back: Right Side: Left Side:
clitional work to be oerformed un ert Rigpermit-c ec all tm appy: -
t
❑HVAC Gas;Tank Gas Piping _Shutters •Windows/Doors
I Electric Plumbing r-iSprinklers Generator Q Roof
Total Sq. Ft of Construction:
Sq. Ft.of First Floor:
Cost of Construction:$ ,S�3 � - Utilitiessewer Septic Building Height;
Name Na'me:` o,r1 .1 'tf" ufn J G
a. 1 !
67 y�•c��.f' t ,�,„,i'J ,. �hc,
Com pan y ��Coo
City:r '7l, ./T zjl, ir` 'j i State: Address
ZipCdde City: f7. f'�LGi�r State:he
Phone No. Zip Code: .7YJ f!�6 Fax:7.72-Mdl-4 SJT
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-M ail: To o7., ,t k'z ref: Q..44'?.-Go.�-+
from the Owner listed above) State or County Lice nse:s ce-ti3 ILyd'D.0
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:. _Not Applicable MORTGAGE COMPANY: Not�Applicable
Name:. Name:
Address:__ n /' 1 Address: 04
City: State: City: State:
Zip: Phone: Zip: Phone
FEE SIMPLEtT;ITLE: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 Counter makes no representation that is granting a permit will.authorize the, ermit 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,wyhich 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
_ gnature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA , w STATE OF FLORIDA
COUNTY OF ��V W COUNTY OF
The forgoing instr s acknowlecla efore me The forgoing instru nt w acknowledged before me
this day of 2 by this�,day of 20 V�by
(Name of peracknowledging) (Name of person ac n ledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known,y OR Produced Identification
Type of Identification Produced S dentification Produced
KARE
""""" KAREN IEL'SEN
°a • ®I)Commission#FF 15637 i ion No: :1•"°•'% (fo
Commission NO. _'+ My Commission x G �_, ommiss F 115637
e 12, 2 18 My Commission Expires
�.'•o��.; Jun
4,unH�`
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW. REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS