HomeMy WebLinkAboutST LUCIE COUNTY 12.13.2017.pdf1ALL APPLICABLE INFO MUST T E COMPLETED FOR APPLICATION To BE ACCEPTED
Late:
Permit Number:
4' J
Maw.; Building Permit Application
Planning and Development Services
Building and Cache Regulation Division
2300 Virginia Avenue, Fart Fierce FL 34982
Phone. (772) 46-1553 Fac: (772) 462-1578
Commercial
Residential '�
PERMIT APPLICATION! FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT EMENT LOCATION.
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Address. al, P U
Legal 'Description:
Property Tai !D :
Site Plan Name:.
Project Name:
Setbacks Fent Back:
DETAILED DLSCI I PTI f F FORK:
CONSTRUCTION
INFORMATION:
zgErionai wo
HVAC
❑Electric
0 oe errormea
LJ Gas Tank
Plumbing
Total Std. Ft of Con tru tow
Cost of Construction: $ &
Right Side:
tinder this permit —the
❑Gas Piping
Sprinklers
C-
Left Side:
„ a r
U Shutters
Generator
Lot N o .
Block No.�..
Windows/Doors
Roof
S. Ft. of First Floor:
Utilities: USewerSeptic Building Height:
Roof pitch
OWNER/LESSEE:
CONTRACTOR:
Name S Lk )(\ Ck `Lk.),YJCl_ .&e'
Name: Woc--,�
Address_ C220,
Company:
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Cit . ..3': �' �r.+tt1r• 4
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Zip Code:. `� ' Fax:
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Phone No. �
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-Mail.
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Phone No.°-
Nil Irk fee simple Title Holder on net e' if different
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from the Owner listed above)
State orCountyLien e.
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL ENTAL C N T U TI N LIEN LAW INFORMATION.
DESIGNER/ENGINEER; Not Applicable I MORTGAGE COMPANY:
Name:
Address:
City:
zip:.
State:
Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
e:
Address
City:
1p:
Phone:
Not Applicable
Name:
Address:
City: State;
Zip: phone:
BONDING COMPANY:
Name:
Address.-
City:
dire s.
City:
ip;ore:
Not Applicable
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 Hayne Owners Association rules, bylaws car ars covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review veour deed for any restrictions which ma ► apply.
In consideration of the granting of this requested permit, I do hereby agree that F will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and t_ Lucie County Amendments_
The following building permit applicatlons are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessary 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 ars attorney before
commencina work ac recordiniq vour Notice of Commencement.
S
Signature of Winer/
STATE OF FLORIDA
COUNTY OF r
see'ontract ent far +2vwrner~
The forgoing instr ent waskno lecEgee#ore me
this day of � � � �.. 20 by
7
Signature of C ontra r Licen e_Holder
TATE of FL01 IDA
COUNTY OF
11
L4 f
The far oing instr ent was 4cknowledged before me
this day of CCIM by
(Name of pion i4cknowledgiD (Name of pi n a now ledging
(Signature of 4at`ruhli
ite of Ronda
Personally Known Produced Identification
Type of 'Identification Produced
'4? 1- ? 6?
iwtr-- Mate of � terrcia )
Personally Known OR Produced Identification
Type of Identification Produced
Commission .. k Y� y��� � pl/4f I+F i�� � 4� �191�i7 o l LLF issio 1 Silo. Iki7IPI!
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