HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: y\ Permit Numper:
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7.45�M'M-3 Y FJJ- RECEIVED
Building Permit Applicatiott NOV 2 2 2919
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial ilesidential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at tie end of line A. �iz)t (
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Legal Description: RC)k L ntf-" I
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Property Tax ID#: 13 1 D -9 c�xzz)
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Site Plan Name: Le_w4s, Block No.
Project Name:�e_-RzC_L/ ns
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Aciclitionalwon Ktobe erformed under this permit—check all tm apply:
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1:JHVAC Gas Tank F]Gas Piping HShutters s. ZWindows/�.010_rs
0 Electric O Plumbing OSprinklers FIGenerator 01 Roof
Total Sq. Ft of Construction:. Sq. Ft.of First Floor:
Cost of Construction:$ Utilitiesl_]SewerFlsepti"� Building Height:
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Name Name: Q1
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Address:'5 30 L/ COC. Ie,Dic Company: . -4- c) CA i-&e to
City: E6 r- e�e—vc—e State: Address: i,S a le 1 1-75 TH _L)z:
Zip Code:. `f q,5 I Fax: City: - State:
Phone No. )09—&t-t. Lt Lf 9 Zip Code:- L Fax: 5 X6115
E-Mail: Phone No. 5-Le ?-'s-4T- 4-/o
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: 0 0
If value of construction is$2500 or more,a RECORDED Notice of Commencement is requir6d.
SUPPM`E'�UTAL��ONTRUCTION.LIEN LAW INFORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY. Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: PI-one:
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 apermit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and cover ants 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 that4 will,in all -espects,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 n:view: 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 recon ed and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with len:Jer or an attorney before
commencing work or recording our Notice of Commencement.
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_Signature of Owner/Lessee/ gent nature of Contractor/L cense Holder
STATE OF FLORIDA "� STATE OF FLORIDA
COUNTY OF COUNTY OF—VA la, / P42r. h
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this 4 ll day of G 20 L'�_by this day of .20 0__by
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(Name of person acknowledging) (Name of person acknowl=_dgtng)
(Signa re of Notary Public-State of Florida) (Signatu of Notary ubl c-Stat f Florida)
Personally Known OR Produced Identification Personally Known '✓ OR Produced Identification
Type of Identification Produce} A yF_uOM Type of Identification Produced
Commission No. * * ==2111,211123 Commission No. 1 ARv�r ANd&;ANG
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� � lNOrtt/>•ti� MY COMMISSION#FF 951069
pF b1. fia10d ibY Bu�l ,r
EXPIRES-Andl 12 2221)
lFOF F`04� 0000d Thtu Budget Notary Suites
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS