HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: ,�-iI "i � Permit Number:
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
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: k'te CJ�c>v ��`c7{ 1 ,�•Lecwt_ 1�; .
Legal Description: bf L-:+- La
_OA41
Property Tax ID ##: C)� -- C) I I - c - Lot No.
Site Plan Name:
Project Name: _ 7C,A-h r c'Dr- S
Block No.
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
00 0 -r - p er' n � f ;r � 7 �fGs . ups
!1
under this oermit-
UHVAC Gas Tank
Electric Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 1 1
Piping Shutters 11 Windows/Doors
nklers OGenerator 0 Roof Roof pitch
S Ft. of First Floor: _
i}tllEtieSSewerSeptic
Building Height:
OWNER/LESSEE:
CONTRACTOR.
Name.- S-4- Lx_&c: < C'Cc.2'Ln±!a
Name: _�)
company: _ AQ G
NS
Address: (fq 136' v' L
Address: Al EL?�:2 Vi rte,, J1 `� , e
City: !- l� c,� State:lam
Zip Code: lLo 73 Fax:
Phone No. =7?.1- 3'S9 - 0 tlZi
City: t'� �; �L�
p Code:
Phone No.??ems r)�
State: l`t
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16- Sq
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E -Mail: ba k&('-&- � €'_C.D , Grq
Fill in fee simple Title Holder on next page ( if diffe ent
from the Owner listed above)
E -Mail: CJ '^ . rt C_
C'T C&Voek 51 , ^T
State or County License:
7`I`
it value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Add rens:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER, f 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.
5t. Lucie County makes no representation that is granting a permit will authorize thepermit 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 pians, the Florida Building Codes and St. Lucie County Amendments -
The following building permit applications are exempt from undergoing a full concurrency review: rooms 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
cofinmencinL Work or rP.cordinR vnter Nnfir p of rnmmanramant
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natar acto cense Holder
ss/+it�5cc;r as enar?er
Signatur=FLORIDA
STA
E OF FLORIDA
COUNTY OF.___ S cr -
COUNTY OF SI/ c
The forgoing instrum nt was acknowledged before me
The forgoing instrument was acknowledged before me
this _tday of U 5k 20 IJ by
this 2'day of }� s 20 11 by
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Name of person eking statement
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Name of person aking statement
mOR
Personally Known OR Produced Identification
Personally Known Produced Identification
Type of identification
Type of Identification
Produced
Produced
(SigAature of Notary Public- State a
(Sjgnature of Notary Public- State of Flash
Commission Na, r'i- S _ JAS10! M�a lJLERS0N,�
M ataxy Pum State of Florida
Commission # FF 965546
Commission No.5 y r(SealASaly M gAUI ��S
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Expires fab 28, 202D
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REVIEWS
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SUPERVISOR
PLANS
VEGETATION
SEA TUR
GRUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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