HomeMy WebLinkAboutBUILDING PERMIT All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i - D3- is Permit Number:
r
as
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: � 4�� UOL W
Legal Description:
Property Tax ID#: ® - 00 1 LA Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
11 I ���`I'- h 10 1LLL-) bea 4-
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Additional work to be performed under this permit-check all t at app y:
L- echanical _Gas Tank _Gas Piping Shutters _Windows/Doors
Electric _ Plumbing Sprinklers _Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ L4,oC), 00 Utilities: —Sewer —Septic Building Height:
Name Name:
Address: -}It _e LQY-e _ t__ Company: I Aii ILJJ
City: - _, ; [ State: Address: CI (Ie
Zip Code: 349 Fax: City: F-O(--}- P i€'f State:EL_
Phone No.(DILA - L439 - LED i_I Zip Code: 3L_19S1 Fax: D� :$11- SM�
E-Mail: Phone No -T1 ]_ U-31-i- [J'A GI I
Fill in fee simple Title Holder on next page(if different E-Mail C: t z n-)C"from the Owner listed above) State or County Lice nse-CAG-4- i c t9 ocpq
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
LW° QN 11M M fft INFORM , L.............a 'a.-...:.... .._" ._. a:.:.._..... . •.
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:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 fuel 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.
Signature f Owner/Less&_,6to4f ractor as Agent for Owner Signature Contractor/Lic se er
STATE OF FLORIDA STATE OF FLORIDA �}
COUNTY OF � A� COUNTY OF T ' i,
The for oing instrurn ent was acknowledged before me The for oing instrument was acknowledged �,e.fore me
this day of --4 An Viir—k 20fK by this day of y
(Nag6e of person ack wled ing) (NamNri6 of person ackn Jgm�69 I.
CATHIE LEE STULL 'c -. CATHIE LEE STW
N =�� «-;
? =.* * Notary Pubic-State o?E'or:da
otary Au�G c-SrateoiF'.orda T. Comrls A,:
GG 154331
(Signature of Not y . r�tate Qf: s az7.2a22 (Signature of Notary bl'ic ` afe of f�fff&Os,la127.2022
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. /2014