HomeMy WebLinkAboutScott permit appALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
T�
• Building Permit Application
Planning and Development Services
Building and Code Regulation Division
23W Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential <�p
PERMIT.APPLICATION FOR: To Select from dropbox, click arrow at the end of line III'
{ PROPOSED IMPROVEMENT LOCAT1143Ai: M
Address:_34r) S Na(_04.10lCl Ave -
Legal Description: R\s(?)r \-C.L'CYL.-t 1 Y-1IL .21') U)t cZ 9
Property Tax ID ii:
Site Plan Name
Project Name:
Setbacks
Front Back: Right Side: Left Side:
I DETAILED DESCRIPTION OF WORK:
Lot No 199
Block No. .13.a
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CONSTRUCTION INFORMATION:
Additional work to a orme un er -checkispermit a apply:
a4VAC 11 Gas Tank alas Piping _ Shutters Windows/Doors
Electric OPlumbing aSprinklers []Generator �Jyoof ® Roof pitch
Total Sq. Ft of Construction: q
Cost of Construction:$ otl
S Ft. of First Floor: _
Utilities: Sewer a Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: 30y)Y'] 'Buis_
Address:3ga S Nctw')iQA PAft�
Company:
City: rro GA • (�LA6 -e Stater(
Zip Code: 31-1 GISJ Fax:
Phone No. -1 % - I/
Address: %T � � �1�12W u r-
City: fba'9� 1 ici-e State:_r-L
Zip Code: cf �f S.2 Fax:
Phone No. 1 -7 9 - XSq- 7 0o
E-Mail: 1f2AS6&
1 DWI
Fill in fee simple Title Holder on next. page ( if different
from the Owner listed above)
E-Mail:
State or County Lic tse: CCC' (3,�041 4:
If value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCT ON LIEN LAW INFORMATION:
DESIGNER/ENGINEER: -Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: \,ffiot Applicable
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 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 full comurrency 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
STATE OF FLORIDA STATE OF FL
COUNTY OF <1:134 . CJU (' P _ COUNTY OF
The forgoing instrument wa acknowledged before me The forgoing instrument was acknowledged before me
this j� day of h 1 M J 20CRQby I this is day of N Cj\� J 20 —&by
'Whn f3uss
(Name of person acknowledging j (Name of acknowh d, g
0
(Signature of otary Public- State of Florida j (Signature a
Personally Known OR Produced Identification Personally Known
Type of Identificati Prodiuced Type of identificat
Commission No.
Revised 07/15/2014
- - AN
Pubw stare m
l `ter: Kelsi Mess _ _ -
M
OR Produced Identification
Public State of
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